This document discusses opportunities for primary care networks and general practices to better collaborate and manage workload. It notes that primary care provides continuity, is community-focused, holistic, and comprehensive, but that current demand exceeds workforce capacity. Opportunities for collaboration through primary care networks include staff pooling, shared functions, specialist services, planning, analytics, recruitment and career development. However, meaningful collaboration requires deliberate effort to build relationships through open communication and joint practical improvements. The document also analyzes sources of workload for general practices and promotes innovations from other practices that can help manage demand and release clinician time.

1. @robertvarnam #NHSLongTermPlan@robertvarnam #NHSLongTermPlan
Time for Care
Dr Robert Varnam PhD MRCGP MSc
Director of Professional Leadership for Improvement
Improvement Directorate
NHS England and NHS Improvement
@robertvarnam
bit.ly/190515tandridge

2. @robertvarnam #NHSLongTermPlan
Pressure Opportunity

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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

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Continuity
Community focussed
Holistic
Comprehensive
STRENGTHS OF PRIMARY CARE
Central
BUT …
Demand >> workforce
Practices are set up to provide
mostly medical care (reactive,
individual > proactive, population
focused)
Most lack collaborative
relationships required to truly be
central to patients’ care
Too small and isolated to have
significant impact on population or
system

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Primary care networks: Opportunities for practices

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Primary care networks: Opportunities for practices

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 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

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 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

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 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

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 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

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 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

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

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Benefits are not automatic
Some mergers achieve little
Some ‘alliances’ achieve much
You need a deliberate plan
Primary care networks: Opportunities for practices

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System: 1m+
“Integrated care system”
Major partnerships & shifts in priority
Workforce & infrastructure planning
Large scale service reconfiguration
Place: 100 – 500k
“At Scale Primary Care Provider” / “Federation”
Organisational infrastructure & governance
Specialist staff & services
Employment & career development
Model design and population wellbeing
Partnerships with all health & care providers
Neighbourhood: 30-50k
“Primary Care Network”
Urgent care and resilience
Locality-tailored services
Shared MDT
Partnerships with local providers
General practice
Coordinated, complex, multidisciplinary
care
‘Place of belonging’ for patients needing
continuity
Doing the right thing at the right scale

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Building meaningful collaboration

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Building meaningful collaboration
1. It’s pivotal
The quality of collaboration,
and the extent to which it
pervades the whole culture
for all staff, is one of the
biggest determinants of
success or failure in joining
up care.
2. It’s hard
Success is not guaranteed,
and doesn’t “just happen”
without deliberate effort
and clear plans.

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Building meaningful collaboration
Common pitfalls
• Ignore it as an issue
• Talk about theories / governance
• Focus on our differences
• Keep talking until every detail is planned
BUT …
• Most people in general practice are very practical
• There is more that connects us than separates us
• We can’t fully know what the future holds

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Building meaningful collaboration
So how about …
 Talk: share what you’d like to achieve
 Agree: one or two things to do - together
 Do it: work on those improvements together
 Then: develop structures to sustain the new ways of working
‘Collaborate’ is a verb, not a structure

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Manage our workload better

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74%
7%
6%
4%
3%
3%
2%
2%
Potentially
avoidable GP
appointments
(audit by GPs)
Other in practice
Self care/Pharmacy
Outpatients
Sick notes / appeals
Care navigation
Continuity/preparation
Other
Data from 5,128 consultations
bit.ly/time4caretool1
GPs judged 26%
of their consultations
to be potentially avoidable

21. @robertvarnam #NHSLongTermPlan
74%
7%
6%
4%
3%
3%
2%
2%
Other in practice
Self care/Pharmacy
Outpatients
Sick notes / appeals
Care navigation
Continuity/preparation
Other
Data from 5,128 consultations
bit.ly/time4caretool1
GPs judged 26%
of their consultations
to be potentially avoidable
… 18% are about
how the practice
manages its workload
Potentially
avoidable GP
appointments
(audit by GPs)

22. @robertvarnam #NHSLongTermPlan
GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions
Innovations from around England
that release time for GPs to do
more of what only they can do.
bit.ly/gpcapacityforum

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Innovations from practices
throughout around England that
release time and improve care.
bit.ly/gpcapacityforum
GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions

24. @robertvarnam #NHSLongTermPlan
Innovations from practices
throughout around England that
release time and improve care.
bit.ly/gpcapacityforum
GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions
bit.ly/gpcapacityforum

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Your own Time for Care programme
bit.ly/T4Cmay2019