Keynote talk at Best Practice 2018. Observations about the critical success factors for leaders wishing to unpack the potential of primary care networks to benefits patients and GP practices.

1. @robertvarnam@robertvarnam
• Dr Robert Varnam
Clinical lead for primary care transformation
• Sustainable Improvement Team
@robertvarnam
Primary Care Networks
bit.ly/20181018birmingham
Why? How?

2. @robertvarnam@robertvarnam
Primary Care Networks
bit.ly/20181018birmingham
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls

3. @robertvarnam@robertvarnam
Primary Care Networks
bit.ly/20181018birmingham
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls

4. @robertvarnam
Continuity Accessible personal
care built on a relationship from cradle
to grave
Community focussed Responsible for
a registered population, improving wellbeing
Holistic Dealing with the patient as a
person not a disease or part of the body
Comprehensive Handling wide range
of problems, managing clinical uncertainty
STRENGTHS OF PRIMARY CARE
Central Coordinating and connecting
other teams, referring where appropriate

5. @robertvarnam
Continuity
Community focussed
Holistic
Comprehensive
STRENGTHS OF PRIMARY CARE
Central
Constraints on delivering
the full potential:
Demand >> workforce + funding
Practices are set up to provide mostly
medical care (reactive, individual >
proactive, population focused)
Hard to coordinate other inputs and ‘pull
in’ specialist support
Too small and isolated to have significant
impact on population or system
Primary care doesn’t need reinventing, but liberating to deliver its potential

6. @robertvarnam
Specialists
Community
services
1948 CARE

7. @robertvarnam
Self
Care
Broader skillmix
Self
management /
social
prescribing
Emergency
care
Collaboration
with specialists
At scale
FUTURE CARE

8. @robertvarnam@robertvarnam
Primary Care Networks
bit.ly/20181018birmingham
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls

9. @robertvarnam@robertvarnam
Primary Care Networks
bit.ly/20181018birmingham
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls

10. @robertvarnam
Primary care networks: Opportunities for practices

11. @robertvarnam
Primary care networks: Opportunities for practices

12. @robertvarnam
 Staff pooling
• nurses, reception & clerical staff,
sessional GPs … internal ‘bank’
 Overflow support
• phone consultations
• access hub (phone +/- face-to-face)
• home visiting
Primary care networks: Opportunities for practices

13. @robertvarnam
 Purchasing
• Indemnity bulk purchasing
• Supplies & utilities
 Shared functions
• CQC registration
• Accounting
• Policies & procedures
• Procurement
• Correspondence management
• IM&T (eg support & maintenance, intranet, web,
social media)
 Specialist functions
• HR
• Finance
• Clinical governance
• Business intelligence
Primary care networks: Opportunities for practices

14. @robertvarnam
 Planning
• Workforce
• Infrastructure development
• Service reconfiguration
• Public health
 Provision
• Acute care
• Community pharmacy
• Dentistry
• Optometry
• Social care
• Housing
• Welfare
• Voluntary sector
Primary care networks: Opportunities for practices

15. @robertvarnam
 Traditional healthcare roles
• Pharmacists
• Specialist nurses
• Physiotherapists
• MH therapists
• Paramedics
 Wellbeing workers
• Social workers
• Care navigators
• Health trainers & coaches
• Welfare advisors
Primary care networks: Opportunities for practices

16. @robertvarnam
 Sharing ideas
 Testing new ideas
 QI expertise
 Patient engagement
 Analytics
• Population health analytics
• Priority setting
• Benchmarking
• Realtime measurement
 Project management
 Research participation
Primary care networks: Opportunities for practices

17. @robertvarnam
 Recruitment
 HR
 CPD
 Career development
• New options
• In-house portfolio career
• eg
• Teaching
• Leadership
• Mentoring
• Service improvement
• Research
Primary care networks: Opportunities for practices

18. @robertvarnam
Benefits are not automatic
Some mergers achieve little
Some ‘alliances’ achieve much
Primary care networks: Opportunities for practices

19. @robertvarnam@robertvarnam
Primary Care Networks
bit.ly/20181018birmingham
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls

20. @robertvarnam@robertvarnam
Primary Care Networks
bit.ly/20181018birmingham
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls

21. @robertvarnam
What size should we be?
 Personal focus
 Clarity
 Commitment
 Agility
 Population focus
 Alignment
 Priorities
 Partnerships
20 100
Don’t accept
either / or
solutions

22. @robertvarnam
System: 0.5-3m
System partnerships for large scale change
Workforce & infrastructure planning
Major partnerships & shifts in priority
Place: 100-900k
Strategic partnerships
Organisational development infrastructure
Corporate support
Career development
Population wellbeing
Neighbourhood: 30-60k
Acute care
Shared MDT
Population management
Business functions
Team: 4-30k
Place of belonging
Doing the right thing at the right scale
Microteam: 2-500
Personal continuity of care

23. @robertvarnam
Building a successful primary care network…
Purpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > form

24. @robertvarnam
Building a successful primary care network…
> ++
Purpose > function > form
Connecting with values and focusing on a better future trumps money and fear

25. @robertvarnam
Building a successful primary care network…
Purpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > form
Connecting with values and focusing on a better future trumps money and fear
Build the culture through practical collaboration

26. @robertvarnam
Building a successful primary care network…
Build capabilities – clinical, improvement, business
Purpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > form
Connecting with values and focusing on a better future trumps money and fear
Build the culture through practical collaboration
bit.ly/20181018birmingham