Common questions about the future of at-scale primary care. Presentation at the RCGP Supporting Federations Network event, 1 Dec 2016

1. #GPforwardview#GPforwardview
What does the future hold
for at-scale primary care?
Dr Robert Varnam
Head of General Practice Development
NHS England
@robertvarnam

2. #GPforwardview
 Is there something meaningful for us to do?
 What size should we be?
 How do we realise the benefits of scale?
 What capabilities will we need?
Asking the right questions

3. #GPforwardview
 Is there something meaningful for us to do?
 What size should we be?
 How do we realise the benefits of scale?
 What capabilities will we need?
Asking the right questions

4. #GPforwardview
Multispeciality Community Provider contract
bit.ly/MCPframe1
Virtual MCP
Alliance contract, overlaid on existing contracts
Partially integrated
Pre-procurement of community services (MCP + GMS)
Fully integrated
Hybrid: NHS Standard Contract & primary medical services
Single, whole population budget for all services covered
New performance element (replacing CQUIN & QOF)
Risk share for acute activity

5. www.england.nhs.uk @robertvarnam
UK general practice is one of the world’s most comprehensive embodiments of the
founding principles of primary care…
Personal care built on a
relationship from cradle to grave
Community based responsible for
prevention and care of a registered population
Holistic perspective understanding
the whole patient not just a disease
Comprehensive skills to
diagnose & manage almost anything
Personal and population-orientated primary care is central …
if general practice fails, the whole NHS fails. Simon Stevens, General Practice Forward View
First port of call and
central point of care
for all, for life

6. www.england.nhs.uk @robertvarnam
Self
Care
Broader skillmix
Self
management /
social
prescribing
Emergency
care
Collaboration
with specialists
At scale
Population wellbeing management
and holistic person-centred care
provided by a multiprofessional team
led by the GP, supported by at-scale
collaboration and efficiencies.

7. #GPforwardview
 Is there something meaningful for us to do?
 What size should we be?
 How do we realise the benefits of scale?
 What capabilities will we need?
Asking the right questions

8. #GPforwardview
 Is there something meaningful for us to do?
 What size should we be?
 How do we realise the benefits of scale?
 What capabilities will we need?
Asking the right questions

9. @robertvarnam
Clarity
Commitment
Agility
Alignment
Priorities
Partnerships
4 400
We need
the best of
both worlds
What is the ideal size?

10. #GPforwardview
STP footprint: 300k-2m
Workforce & infrastructure planning
Large scale service reconfiguration
Major partnerships & shifts in priority
MCP: 100-350k
Organisational infrastructure & governance
Specialist staff & services
Employment & career development
Model design (population management, care models)
Strategic partnerships
Hub/Home: 30-60k
Acute care
Locality-tailored services
Shared MDT
Place of ‘belonging’
Core team: 3-4k
Coordinated, complex
multidisciplinary care
Continuity

11. #GPforwardview
 Is there something meaningful for us to do?
 What size should we be?
 How do we realise the benefits of scale?
 What capabilities will we need?
Asking the right questions

12. #GPforwardview
 Is there something meaningful for us to do?
 What size should we be?
 How do we realise the benefits of scale?
 What capabilities will we need?
Asking the right questions

13. #GPforwardview
Working at scale: Opportunities for practices

14. #GPforwardview
 Staff pooling
• nurses, reception & clerical staff, sessional GPs
 Overflow support
• phone consultations
• access hub (phone +/- face-to-face)
• home visiting

15. #GPforwardview
 Purchasing
• Indemnity
• Supplies
• Utilities
 Shared functions
• Policies & procedures
• Procurement
• Correspondence management
• IM&T (eg support & maintenance, intranet, web, social media)
 Specialist functions
• HR
• Finance
• Clinical governance
• Business intelligence

16. #GPforwardview
 Planning
• Workforce
• Infrastructure development
• Service reconfiguration
• Public health
 Provision
• Acute care
• Community pharmacy
• Dentistry
• Optometry
• Social care
• Housing
• Welfare
• Voluntary sector

17. #GPforwardview
 Traditional healthcare roles
• Pharmacists
• Specialist nurses
• Physiotherapists
• MH therapists
• Paramedics
 Wellbeing workers
• Social workers
• Care navigators
• Health trainers & coaches
• Welfare advisors

18. #GPforwardview
 QI expertise
 Analytics
• Population health analytics
• Priority setting
• Benchmarking
• Realtime measurement
 Project management

19. #GPforwardview
 HR
 CPD
 Career development
• Leadership
• Mentoring
• Service improvement
• Research

20. #GPforwardview
 Is there something meaningful for us to do?
 What size should we be?
 How do we realise the benefits of scale?
 What capabilities will we need?
Asking the right questions

21. @robertvarnam
Leadership
Creating shared
purpose
Strategic
planning &
partnerships
Leading through
change
Being a leader
Improvement
Patients as
partners
Process design
Using data for
improvement
Rapid cycle
change
Business
Team leadership
Operations
management
H R
I T
At-scale
working
Governance
Contracts
Workforce
Business
intelligence
Capabilities for the future
Interdependent capabilities for leaders & organisations

22. @robertvarnam
www.england.nhs.uk/gpdp
Local Time for Care
programmes
• Bespoke 9-12 month
programme to support a group
of practices to implement
innovations that release time
for care.
• Training for reception and
clerical staff, for active
signposting and document
management (£45m over 5
years).
• Funding towards purchasing
online consultation systems
(£45m over 4 years, from
2017).
• CCG transformational
support (£171m over 2 years,
from 2017).
General Practice
Improvement Leaders
• At least 400 free places a
year for three years.
• Skills and confidence in
designing and implementing
improvements within the
practice rapidly and
sustainably.
• RCGP Supporting
Federations Network and
NHS Collaborate (NAPC &
NHS Alliance) for leaders of
at-scale primary care.
• Funding facilitated peer
networking for practice
managers of all 7,800
practices, with support to
develop professional skills.
• Local showcase events
• Web resources
• Fortnightly webinars
• Network of champions
10 High Impact Actions
to release time for care