160302 gpaf lessons, nottingham
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A very brief summary of lessons emerging from the GP Access Fund after the first year
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160302 gpaf lessons, nottingham
- 1. www.england.nhs.uk @robertvarnam Dr Robert Varnam Head of general practice development The GP Access Fund Reflections & lessons @robertvarnam
- 4. www.england.nhs.uk @robertvarnam An example of this in practice at the moment is the Prime Ministerās GP Access Fund. Now covering a significant proportion of the country, practices in this are implementing quite wide-ranging redesign of their services, acknowledging that extended hours are only one part of good access. The practices participating in this programme are already beginning to implement many of the transformational changes envisaged by the Five Year Forward View. This is generating valuable learning about the specific changes required, including the ways in which the system can make progress easier and more sustainable. Wave one Wave two 57 schemes 2,500 practices 18m patients 100 āfederationsā (approx) The Prime Ministerās GP Access Fund bit.ly/GPAFresources
- 5. www.england.nhs.uk @robertvarnam Right place Right time Right person Right care A new definition of good access Right Access
- 6. www.england.nhs.uk @robertvarnam Redesign areas Wider primary care at scale Reshape demand Active front-end Contact modes Match capacity & demand Rapid access model Release capacity Extended hours Service redesign team Broaden skillmix Complex care model Premises I.T. Workforce ServicecomponentsSystemenablers
- 8. www.england.nhs.uk @robertvarnam Innovationsā efficacy Schemesā efficacy Funding No. & time & type of appointments Cost-effectiveness Conditions for success Successful innovations Logic model Patient satisfaction Staff assessment OOH attendance A&E attendance Data submitted by local schemes Data obtained by national evaluation provider Analysis by national evaluation provider Dissemination of learning by NHS England
- 9. Extended hours 75,000 55,000 ARE PROVIDED BY A GP ADDITIONAL 38,000 28,000 ARE PROVIDED BY A GP TOTAL
- 10. Core working hours TOTAL 930,000 OVER HALF PROVIDED BY A GP ADDITIONAL 37,000 7,000 ARE PROVIDED BY A GP
- 11. 94% UTILISATION DURING CORE HOURS SAME AS BASELINE UTLISATION DURING EXTENDED HOURS 75% COMPARED TO 80% BASELINE Utilisation of hours EVIDENCE SUGGESTS THAT 41-51 EXTENDEDHOURSPERWEEK ARE REQUIRED PER 100,000 PATIENTS
- 12. Patient satisfaction Over 90% consider their appointments convenient 3 out of 4 consider their experience of making an appointment to be good Patient engagement activities Feedback from local surveys is positive, without exception
- 13. 60% of staff rate their experience through PMCF as positive 20% of respondents are dissatisfied with their job Over 50% rate the impact of PMCF on staff as positive Staff satisfaction 70% of respondents are satisfied with how primary care is being offered
- 14. 13 pilots have seen a statistically significant reduction in minor A&E attendances Reduction of 29,000 attendances IMAGE IMAGE Reducing demand elsewhere in the system SOME PILOTS WITH OBSERVED CHANGE IN EMERGENCY ADMISSIONS OR OUT OF HOURS SERVICES -14% -4%
- 15. Ā£3.2 MILLION ANNUALISED A&E SAVING Costs Ā£45 MILLION Ā£ Ā£ Ā£ Ā£ Ā£ AVERAGE COST PER TOTAL EXTENDED HOUR (GP costs similar to locum costs) Ā£200-Ā£280 NEW MODES OF CONTACT SHORTER & SHOWING POSITIVE COST BENEFIT SIGNS ALTERNATIVE STAFF PRACTITIONERS PROVING EFFECTIVE AND COST EFFECTIVE
- 16. www.england.nhs.uk @robertvarnam The future of general practice Asking better questions
- 17. www.england.nhs.uk @robertvarnam Top questions Iām asked What size ? What structure & legal entity? Weāre a federation. What now?
- 18. www.england.nhs.uk @robertvarnam ļ¼ Clarity ļ¼ Buy-in ļ¼ Agility Does size matter? ļ¼ Alignment ļ¼ Priorities ļ¼ Partnerships 2 300+ Only everything will do
- 19. www.england.nhs.uk @robertvarnam We should be big AND small Team Hub System Units
- 20. www.england.nhs.uk @robertvarnam Top questions Iām asked What size ? What structure & legal entity? Weāre a federation. What now?
- 21. www.england.nhs.uk @robertvarnam Association Network Federation Partnership Superpractice Structure & legal entity 5 yearsContemplation
- 22. www.england.nhs.uk @robertvarnam Structure & legal entity Whitstable medical practice
- 23. www.england.nhs.uk @robertvarnam Structure & legal entity AT Medics, London
- 24. www.england.nhs.uk @robertvarnam Structure & legal entity ā¢ staff pooling ā¢ shared training ā¢ common policies & procedures ā¢ new specialist input e.g. Wakefield, S Cotswolds, Bristol, Richmond
- 25. www.england.nhs.uk @robertvarnam Top questions Iām asked What size ? What structure & legal entity? Weāre a federation. What now??
- 26. www.england.nhs.uk @robertvarnam Our purpose What do we want to d Who do we need? How will we do it?
- 27. www.england.nhs.uk @robertvarnam Asking better questions What shall we achieve? Who is āusā? What capabilities will we need? What ways of working will serve us best? How should we lead? What infrastructure will support us?
- 28. www.england.nhs.uk @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 Organisation Governance Operations management Workforce Business intelligence Capabilities Enablers Innovation spread Policies & permissions Contracts & incentives Infrastructure Productive federation Transparent measurement Capabilities for the future What do teams and individuals need? Interdependent capabilities for leaders & organisations How can the system catalyse & accelerate change?
Editor's Notes
- PC at the heart ā access will need to improve
- General practice is brilliant Rightly admired High quality Most appropriate for most people In growing demand But struggling - and too hard to access. 12% of patients experience difficulty.Ā Chief thing staff worry / stress about, too
- In every scheme, data will be gathered about changes in general practice appointments, and the impact of these on outcomes at the level of the patient, the wider system and staff. This will allow calculations of the efficacy with which schemes use the funding to implement service innovations, the efficacy of those innovations in changing outcomes, and the cost-effectiveness of each scheme and the programme overall. Lessons will be drawn about successful innovations and the conditions for successful deployment of them, and these will be disseminated as actionable learning for commissioners and providers. This is Workstream A.
- Copy in
- Copy in
- April ā add in some money symbols/stacks to make it look nice (not major priority if you run out of time) DONE
- These are the wrong questions
- False polarities
- These are the wrong questions
- 34k
- These are the wrong questions
- Experience of federations give a single contract to achieve a real thing
- One of the tasks of the Call to Action was to identify the actions necessary to promote, support and sustain the adoption of the kind of innovation and improvements we seek. We consulted with practice managers, clinicians, commissioners, policy makers and improvement experts, as well as drawing on the experience of building primary care improvement capability in the UK and internationally. A comprehensive list of areas emerged from this process. This has been tested and refined through ongoing consultation with innovators and professional leaders. The framework describes a set of intrinsic capabilities required by practices to lead service change rapidly, safely and sustainably, and a set of enablers which can be used by policymakers and commissioners to make change easier and more sustainable. Since April 2014, we have had the opportunity to use this framework in support of 1100 GP practices across England in the Prime Ministerās Challenge Fund. As these 20 groups of practices have introduced a range of service innovations, they have received a bespoke programme of capability-building and direct access to national support for key enablers. Feedback from practices and leaders has been very positive, with many examples of faster and better progress being made as a result of it. NHS England are now considering ways in which this framework can be used to secure support for other national initiatives, for example further extension of access improvements, support to workforce innovators and a programme to release capacity through reducing workload and working differently.