Challenge fund update, Windsor 141125
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View the video at https://vimeo.com/113578615 (password "cumberland") Presentation to RCGP Thames Valley leadership event, Cumberland Lodge, Windsor on 25.11.2014.
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Challenge fund update, Windsor 141125
- 1. PM Challenge Fund update Dr Robert Varnam Head of general practice development robert.varnam@nhs.net Windsor 25.11.14 www.england.nhs.uk Video at vimeo.com/113578615 Password “cumberland”
- 2. Does general practice have a future? www.england.nhs.uk
- 5. Why improve access? • Patient safety • Efficacy • Confidence • Expectations • Pressure (victims of our success?) www.england.nhs.uk
- 6. What do we mean? www.england.nhs.uk
- 7. We don’t mean… www.england.nhs.uk
- 8. Health & wellbeing-promoting care Responsive access Consistently high quality Holistic, personalised, proactive, coordinated care ‘Wider primary care, at scale’ bit.ly/GPpolicy2014
- 9. www.england.nhs.uk Patient System Team Professional What kind of care do we want people to get? What approach would deliver that? Who should be involved? How should they work? What work should be done? By whom?
- 10. Patients, their families and carers confident that they will get the right support at the right time, 24/7. It is straightforward to obtain the right care at the right time from the most appropriate healthcare professional, through simple and well publicised routes of entry to care. There is a flexible response to individual needs, through a greater diversity of consultation types and lengths, including greater use of telephone, online and video consultations. Providers make use of a broader skill mix to match staff expertise to the individual’s need and ability to improve capacity. The barriers between community-based and hospital-based providers of urgent and elective care are removed and pathways are improved, to reduce delays, duplication and gaps in care. Responsive access to care www.england.nhs.uk
- 11. www.england.nhs.uk Patient System Team Professional What kind of care do we want people to get? What approach would deliver that? Who should be involved? How should they work? What work should be done? By whom? Timely, flexible, ‘right care’ Wider primary at scale. One patient, one record. Joined-up commissioning, clear accountabilities. Seamless collaboration across journey. Multi-professional. Working to ‘top of skills’. Supported by system. Able to pull in other expertise.
- 12. What are people doing? www.england.nhs.uk
- 13. Prime Minister’s Challenge Fund <100k 100-250k >500k www.england.nhs.uk (UK-Wide) Patients covered: Wave one - 254 expressions of interest which would have served some 35 million patients but cost £480m In April 2014, 20 pilots were announced involving over 1,100 practices and covering 7.5m patients Population covered
- 14. 1. Understand different needs 2. Reshape demand 3. See the whole system 4. Variety of supply
- 15. How to get there? www.england.nhs.uk
- 16. Health & wellbeing-promoting care Responsive access Consistently high quality Holistic, personalised, proactive, coordinated care ‘Wider primary care, at scale’
- 18. Two specimens Multispeciality Community Providers (MCPs) Primary and Acute Care Systems (PACS) www.england.nhs.uk
- 19. Two specimens Multispeciality Community Providers (MCPs) GP practices Community nurses Therapists Diagnostics Pharmacy Dentistry Specialists www.england.nhs.uk
- 20. At-scale primary care? www.england.nhs.uk bit.ly/GP4Ps Purpose Partnerships Proactivity Possibility
- 21. Tips for success www.england.nhs.uk
- 23. Our shared purpose Is there a clear purpose for change which is understood by all participants, and to which all are committed? • Is it clear why you’re doing this? • Does that connect with others’ motivation? Bring everyone together to agree what you want to achieve through this programme. Always include the purpose in communications. www.england.nhs.uk
- 24. Engagement to mobilise Who needs to be part of this change? How are they enabled to be collaborators and to take action themselves? • Do practices & patients feel like collaborators? • How to maintain engagement? Develop initial plans in close collaboration with everyone who needs to be part of the change. www.england.nhs.uk
- 25. Leadership for change Does everyone you need to lead think of themselves as a leader? Do they have the right skills and support? • Leadership ≠ management • Don’t be a hero • Time, time, time! Start including others in your leadership team now. Budget for leadership time & support. www.england.nhs.uk
- 26. Spread of innovation How will innovations be adapted for local use? How will you rapidly refine innovations before rolling out? • You’re not that unique – learn from others • Very few little is plug’n’play • ‘Iron out’ before ‘roll-out’ Consider where to have a phased approach for piloting. www.england.nhs.uk
- 27. Improvement methodology What improvement methodology(s) will be used to help redesign and improve systems and processes of care? How will practices be supported to work smarter, not just harder? • Release capacity before anything new • Ask practices to work smarter not harder • Build improvement science skills Ask NHS Improving Quality how improvement tools could help www.england.nhs.uk
- 28. Rigorous delivery What approach will be used for programme planning and delivery? How much management staff time will be needed? • This is a major large scale change programme. • Ensure sufficient time. • Secure the right skills. • Use proper systems. Budget for additional management capacity, rather than expecting practice staff to find extra time. www.england.nhs.uk
- 29. Transparent measurement Are measures being used which will stimulate curiosity, drive improvement and demonstrate progress? Are continuous statistical methods used, to provide realtime feedback? • Choose a small number of metrics. • Select metrics in consultation. • Plan to produce feedback early. Have a plan and budget for data collection www.england.nhs.uk
- 30. National metrics Patient contact, as a direct result of the change in access 1. The change in hours offered for patient contact; 2. The change in modes of contacts; 3. The utilisation of additional hours offered; and 4. Impact on the ‘out of hours’ service. Patient experience/satisfaction, including patient choice 5. Satisfaction with access arrangements; and 6. Satisfaction with modes of contact available. Staff experience/satisfaction 7. Satisfaction with new arrangements Wider system change. 8. Impact on the wider system attendances 9. Impact on emergency admissions www.england.nhs.uk
- 31. System drivers How does this innovation align with the priorities of local strategy? Does the environment within which practices and staff operate make it easy to develop and implement innovations? • IT, premises, workforce • Where to connect/piggy-back? • What would make this sustainable? Plan together with commissioners from the outset www.england.nhs.uk
- 33. Health & wellbeing-promoting care Responsive access Consistently high quality Holistic, personalised, proactive, coordinated care Our Federation vimeo.com/album/3133652
Editor's Notes
- *** RECORDING ***
- There are a number of reasons why patients, politicians, policymakers and professionals are looking at access and the availability of services.
- We are not working towards a vision which includes: 24/7 access to ‘your GP’ a focus on improving access in isolation of the other things which make up good care (‘the right access to the right care’ – inc continuity – is very important) a focus on quality of care, irrespective of how hard it is for patients to get access to it – there’s no point in great care people have to wait too long for
- This can be a controversial and even emotive topic for healthcare professionals, who feel they are continually being asked to work harder, faster or longer. That’s why it’s important for us to be very clear that designing healthcare systems requires us to start with the patient and what we want to offer them, and work back towards the implications for individuals.
- This is our draft description of the kind of care we wish to offer patients, in the area of access, which is one of our five ambitions for primary care.
- So here are the key implications, on the right, at each level of the design.
- The PM Challenge Fund is one example of the innovation already occurring in primary care access. It is providing very useful learning about the kinds of innovations and the conditions required to deliver a better service sustainably
- This diagram, taken from one CCG area (Barking, Havering and Redbridge) which is innovating in access, illustrates a number of key aspects of what people are doing. These four key features are common to many programmes.
- In terms of the ‘how’ of planning and leading this kind of change, every component of the NHS Change Model is essential. It is also vital that leaders ensure each is aligned behind the purpose of the change, and not pulling in a different direction.
- In terms of the ‘how’ of planning and leading this kind of change, every component of the NHS Change Model is essential. It is also vital that leaders ensure each is aligned behind the purpose of the change, and not pulling in a different direction.