Releasing time for care - CCGs' role
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Presentation at Commissioning Live Birmingham 2016 about the actions CCGs can take to sustain and transform general practice by releasing time for care.
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Releasing time for care - CCGs' role
- 1. @robertvarnam Releasing time for care in general practice @robertvarnam Dr Robert Varnam Head of General Practice Development robert.varnam@nhs.net
- 4. www.england.nhs.uk @robertvarnam Pressures on general practice ↑ population ↑ consultations ↑ complexity ↑ costs ↓ relative funding ↓ relative workforce
- 5. www.england.nhs.uk @robertvarnam At the heart of the case for change is not the workload of practices – important though that is – it is the needs of patients, and they way they are changing. When the NHS was founded, its purpose was fairly simple. Every now and then, people got ill. When they did, they consulted their doctor. If it was a straightforward problem, they would give a prescription, the person would get better, return to work and, in a year or two, they might need the doctor again. If it was less straightforward, they would be referred to a clever doctor – who would give a prescription or cut out the offending part. The patient would then get better, return to work, and, in a year or two, they might become ill again. That accounted for the majority of the anticipated work of the NHS. And, for some patients, that’s still the kind of care that’s needed. However, a growing proportion of our work is fundamentally different. This now seminal chart illustrates the central fact underlying the quantitative and qualitative change in the work of primary care. It illustrates the rise in multimorbidity with age. As people get older, they have more simultaneous longterm conditions. So that, by the age of 75, for example, at least a third of people are living with four or more LTCs. And, as our demography changes, the proportion of older people increases. Dealing with longterm conditions already accounts for over half of work in primary care. It is set to increase. And, crucially, this represents a qualitative change in the nature of work. These are not people who visit the GP every year or two to get cured of their problem. These are people with problems that we cannot cure – they are living with multiple issues which will not go away, and they visit the GP six, seven, eight or more times a year. At least. Furthermore, the more simultaneous problems someone has, or the greater their frailty, the less helpful it is to pass their care to a doctor specialising in one part of the body. These people need treating as people, not diseases. So the population of people who need what only primary care can offer has grown, the amount of time they need has grown – and both are set to continue growing. This is the chief case for change in primary care, the pressure of patients’ needs. This is not a blip requiring a short-term correction to the priorities of the NHS. It is a fundamental shift which requires every developed nation on earth to turn away from what Muir Gray has termed the ‘century of the hospital’, and place the emphasis where the population’s need is. Scottish School of Primary Care Why change?
- 14. #timeforcare 10 high impact actions to release time for care bit.ly/gpcapacityforum
- 15. www.england.nhs.uk #timeforcare 10 High Impact Actions
- 16. www.england.nhs.uk #timeforcare 10 High Impact Actions bit.ly/gpcapacityforum
- 19. @robertvarnam How can CCGs sustain & transform general practice? Stop obsessing about structure Put new money into primary care Develop workforce & infrastructure Build capable service improvement teams Fund backfill for care redesign Commission ‘right access’ robert.varnam@nhs.net
Editor's Notes
- 2% population growth /yr 2.5% inc in consultations every year since 2007 GP numbers grown by 5,000 FTEs in past 10y - but hospital consultant numbers have roughly tripled
- At the heart of the case for change is not the workload of practices – important though that is – it is the needs of patients, and they way they are changing. When the NHS was founded, its purpose was fairly simple. Every now and then, people got ill. When they did, they consulted their doctor. If it was a straightforward problem, they would give a prescription, the person would get better, return to work and, in a year or two, they might need the doctor again. If it was less straightforward, they would be referred to a clever doctor – who would give a prescription or cut out the offending part. The patient would then get better, return to work, and, in a year or two, they might become ill again. That accounted for the majority of the anticipated work of the NHS. And, for some patients, that’s still the kind of care that’s needed. However, a growing proportion of our work is fundamentally different. This now seminal chart illustrates the central fact underlying the quantitative and qualitative change in the work of primary care. It illustrates the rise in multimorbidity with age. As people get older, they have more simultaneous longterm conditions. So that, by the age of 75, for example, at least a third of people are living with four or more LTCs. And, as our demography changes, the proportion of older people increases. Dealing with longterm conditions already accounts for over half of work in primary care. It is set to increase. And, crucially, this represents a qualitative change in the nature of work. These are not people who visit the GP every year or two to get cured of their problem. These are people with problems that we cannot cure – they are living with multiple issues which will not go away, and they visit the GP six, seven, eight or more times a year. At least. Furthermore, the more simultaneous problems someone has, or the greater their frailty, the less helpful it is to pass their care to a doctor specialising in one part of the body. These people need treating as people, not diseases. So the population of people who need what only primary care can offer has grown, the amount of time they need has grown – and both are set to continue growing. This is the chief case for change in primary care, the pressure of patients’ needs. This is not a blip requiring a short-term correction to the priorities of the NHS. It is a fundamental shift which requires every developed nation on earth to turn away from what Muir Gray has termed the ‘century of the hospital’, and place the emphasis where the population’s need is.
- Published 20 April 2016 GPs are by far the largest branch of British medicine. A growing and ageing population, with complex multiple health conditions, means that personal and population-orientated primary care is central to any country’s health system. As a recent British Medical Journal headline put it – “if general practice fails, the whole NHS fails”. So if anyone ten years ago had said: “Here’s what the NHS should now do - cut the share of funding for primary care and grow the number of hospital specialists three times faster than GPs”, they’d have been laughed out of court. But looking back over a decade, that’s exactly what’s happened.
- overall new investment is min extra £2.4bn pa by 2020-21: Investment rise from £9.6bn (15-16) to over £12bn (20-21) = >10% NHS England budget == 14% real terms inc (almost double 8% for rest of NHS) could be inc further by CCGs, moving care from hospitals one off Sustainability and Transformation package of investments = > £500m over next 5y PLUS continue to make capital investments, est > £900m over 5y
- If that’s the WHAT, this is the HOW These have come from practices around England …not NHSE