This document sets out a blueprint for strengthening general practice in Scotland by addressing increasing problems with workload and GP recruitment. It proposes expanding the number of GPs in Scotland by 740 by 2020 through initiatives like increasing medical school enrollment in general practice, incentivizing doctors to practice in underserved areas, promoting GP returner and retention programs, and launching marketing campaigns to promote general practice as a career. The blueprint also calls for ongoing, sustained investment in general practice infrastructure to ensure the long-term sustainability of GP services that can meet patient needs 24/7.
This document is a manifesto from the Royal College of General Practitioners (Scotland) calling for actions to promote and support general practice ahead of the 2016 Scottish Parliamentary election. It summarizes the challenges facing general practice, including a growing workload amid a shortage of GPs and declining resources that threatens patient care. The manifesto calls on political representatives to commit to increasing the GP workforce through recruitment and retention efforts, replacing the current Quality and Outcomes Framework with a peer-led system of governance, and increasing investment in general practice to 11% of the NHS budget. It provides quotes from GPs and patients to evidence the issues and calls for appropriate actions to address the needs of general practice.
This document summarizes a presentation on pay-for-performance (P4P) programs in the English National Health Service (NHS), specifically the PSS-CQUIN schemes for specialised services. PSS-CQUIN uses incentive payments to encourage quality improvement and value for money in specialised care areas like cancer treatment and mental health. The schemes link a portion of provider funding to performance indicators. While PSS-CQUIN aims to improve care quality, its complexity and lack of evidence linking indicators to outcomes are areas for improvement. An ongoing evaluation will assess PSS-CQUIN's effectiveness and cost-effectiveness to inform future contract designs.
The document discusses joint working between the pharmaceutical industry and the NHS to improve patient outcomes. It provides background on the changing healthcare environment and need for industry and NHS to build new relationships. It defines joint working as situations where pharmaceutical companies and the NHS pool skills and resources for patient-centered projects and share goals. Examples are provided of joint working projects between GSK and two NHS organizations to improve management of COPD. Key lessons for successful joint working include having clear objectives, engaging stakeholders, and being open and honest.
This document provides a summary of the 2018 BMA roadshow content, including contract negotiations updates regarding pay uplifts, indemnity increases, and premises cost directions. It discusses efforts to save general practice through recurrent funding increases, workforce expansion strategies, and managing workload. Recent developments regarding the GP at Hand app, GDPR, and a high court ruling on the GMC appeal are also covered.
The 5 Year Forward View document outlines several new models of care to transform healthcare services in England:
1. Multispecialty Community Providers that would serve as the focal point for a wide range of care in the community, potentially employing consultants and taking over community hospitals.
2. Primary and Acute Care Systems that integrate primary care, hospital, mental health, and community services under one organization with a delegated capitated budget.
3. Urgent and Emergency Care Networks that integrate A&E, GP out-of-hours care, urgent care centers, NHS 111, and ambulance services.
Making the Books Balance – Understanding the Financial Context and Efficiency...NHSScotlandEvent
NHSScotland has an excellent track record in delivering and exceeding efficiency savings targets. In 2011‐12 we will continue to eliminate waste and drive modernisation programmes to achieve productivity and efficiency gains without compromising quality. This session will provide an overview of the challenges that lie ahead for NHSScotland but also the opportunity to ensure we make the best use of the resources that we have.
The document discusses efforts by NHS England to improve retention of GPs in the UK. It notes that the GP workforce has decreased by 1,429 FTE since 2015 due to factors like workload and lack of recognition. NHS England is taking several actions like salary supplements, leadership training, and a GP retention scheme to support GPs. They are also launching intensive support sites in 7 areas and a local GP retention fund. The goal is to make general practice more attractive by understanding retention challenges and spreading success stories.
Review of orthopaedic services: Prepared for the Auditor General for Scotland...meducationdotnet
1. Orthopaedics is a large specialty that treats musculoskeletal conditions through surgery, medication, and rehabilitation. It accounts for a significant portion of NHS spending and activity in Scotland.
2. Waiting times for orthopaedic services have reduced in recent years through changes to service delivery and additional funded activity. However, further improvements to meet 18-week referral targets will be challenging to sustain.
3. There is variation in orthopaedic efficiency across Scotland that is not fully explained by resources or procedures. The report finds opportunities to use existing resources more efficiently through measures like increasing day surgery and reducing hospital length of stay.
This document is a manifesto from the Royal College of General Practitioners (Scotland) calling for actions to promote and support general practice ahead of the 2016 Scottish Parliamentary election. It summarizes the challenges facing general practice, including a growing workload amid a shortage of GPs and declining resources that threatens patient care. The manifesto calls on political representatives to commit to increasing the GP workforce through recruitment and retention efforts, replacing the current Quality and Outcomes Framework with a peer-led system of governance, and increasing investment in general practice to 11% of the NHS budget. It provides quotes from GPs and patients to evidence the issues and calls for appropriate actions to address the needs of general practice.
This document summarizes a presentation on pay-for-performance (P4P) programs in the English National Health Service (NHS), specifically the PSS-CQUIN schemes for specialised services. PSS-CQUIN uses incentive payments to encourage quality improvement and value for money in specialised care areas like cancer treatment and mental health. The schemes link a portion of provider funding to performance indicators. While PSS-CQUIN aims to improve care quality, its complexity and lack of evidence linking indicators to outcomes are areas for improvement. An ongoing evaluation will assess PSS-CQUIN's effectiveness and cost-effectiveness to inform future contract designs.
The document discusses joint working between the pharmaceutical industry and the NHS to improve patient outcomes. It provides background on the changing healthcare environment and need for industry and NHS to build new relationships. It defines joint working as situations where pharmaceutical companies and the NHS pool skills and resources for patient-centered projects and share goals. Examples are provided of joint working projects between GSK and two NHS organizations to improve management of COPD. Key lessons for successful joint working include having clear objectives, engaging stakeholders, and being open and honest.
This document provides a summary of the 2018 BMA roadshow content, including contract negotiations updates regarding pay uplifts, indemnity increases, and premises cost directions. It discusses efforts to save general practice through recurrent funding increases, workforce expansion strategies, and managing workload. Recent developments regarding the GP at Hand app, GDPR, and a high court ruling on the GMC appeal are also covered.
The 5 Year Forward View document outlines several new models of care to transform healthcare services in England:
1. Multispecialty Community Providers that would serve as the focal point for a wide range of care in the community, potentially employing consultants and taking over community hospitals.
2. Primary and Acute Care Systems that integrate primary care, hospital, mental health, and community services under one organization with a delegated capitated budget.
3. Urgent and Emergency Care Networks that integrate A&E, GP out-of-hours care, urgent care centers, NHS 111, and ambulance services.
Making the Books Balance – Understanding the Financial Context and Efficiency...NHSScotlandEvent
NHSScotland has an excellent track record in delivering and exceeding efficiency savings targets. In 2011‐12 we will continue to eliminate waste and drive modernisation programmes to achieve productivity and efficiency gains without compromising quality. This session will provide an overview of the challenges that lie ahead for NHSScotland but also the opportunity to ensure we make the best use of the resources that we have.
The document discusses efforts by NHS England to improve retention of GPs in the UK. It notes that the GP workforce has decreased by 1,429 FTE since 2015 due to factors like workload and lack of recognition. NHS England is taking several actions like salary supplements, leadership training, and a GP retention scheme to support GPs. They are also launching intensive support sites in 7 areas and a local GP retention fund. The goal is to make general practice more attractive by understanding retention challenges and spreading success stories.
Review of orthopaedic services: Prepared for the Auditor General for Scotland...meducationdotnet
1. Orthopaedics is a large specialty that treats musculoskeletal conditions through surgery, medication, and rehabilitation. It accounts for a significant portion of NHS spending and activity in Scotland.
2. Waiting times for orthopaedic services have reduced in recent years through changes to service delivery and additional funded activity. However, further improvements to meet 18-week referral targets will be challenging to sustain.
3. There is variation in orthopaedic efficiency across Scotland that is not fully explained by resources or procedures. The report finds opportunities to use existing resources more efficiently through measures like increasing day surgery and reducing hospital length of stay.
The Hellesdon Hospital was put under special measures due to poor clinical outcomes. An investigation found that the Suffolk Mental Health Partnership had major management issues in 2009-2010, leading it to merge with the Norfolk and Waveney Mental Health Foundation Trust in 2012. A service redesign plan proposed in 2012 aimed to cut costs but faced challenges, and the CEO resigned in 2013 as the plan was implemented. In 2015, the Care Quality Commission found patient needs were not always met and care plans outdated, indicating demoralized staff and poor clinical governance.
HTA training - Claire Gorry - July 26th 2016ipposi
This document provides information about the National Centre for Pharmacoeconomics' (NCPE) initiatives to engage patient communities in Ireland. It discusses the NCPE's patient submission template pilot, which allows patient groups to include the patient perspective in healthcare technology assessment decisions. It provides guidance on completing submissions, including focusing on how a new treatment may help address patient needs and improve outcomes compared to current options. Submissions are limited to 6 pages and included in the NCPE's final reports to help inform reimbursement recommendations.
Sarah khan-for-web-improving-mhcc-conference-15 1209.10.153GDR
NHS England is committed to transforming mental health crisis care services in England. There are several policy drivers to improve crisis care, including the Crisis Care Concordat agreement. NHS England will invest in liaison psychiatry services in acute hospitals and plans to reduce the use of police cells as places of safety. The organization also aims to ensure mental health crisis care is integrated into the Urgent and Emergency Care Review. Additionally, NHS England will develop access and waiting time standards for crisis services through national quality improvement efforts.
This document provides an overview and summary of the planning guidance for the NHS in England for 2015/16. It outlines the key priorities and requirements for the coming year which include maintaining performance standards, implementing new models of care, improving prevention, workforce development, digital transformation, and driving efficiency. Local areas are encouraged to develop plans that align commissioner and provider budgets and activity in line with the priorities of the Five Year Forward View.
The document summarizes the key themes of the NHS 5 Year Forward View plan. It outlines the plan's vision for new models of integrated care focused on populations of 50,000 people. The plan acknowledges an estimated annual funding gap of £30 billion by 2020/21 for the NHS and the need for efficiency savings and increased funding. It also emphasizes the importance of prevention, personalization, technology, and social determinants of health for a sustainable healthcare system.
The document summarizes the work of Academic Health Science Networks (AHSNs) in the UK. It discusses how AHSNs connect the NHS, academics, researchers and industry to spread innovation, improve health, and generate economic growth. Specifically, it provides examples of how AHSNs are:
1) Supporting innovation and enterprise by connecting small businesses with the NHS to drive economic growth and improve patient care.
2) Spreading best practice by connecting clinicians to share innovations and drive improvement across health systems.
3) Creating an infrastructure to enable the development, adoption, and diffusion of innovations by establishing partnerships and funding facilities.
Master slide deck from the Excel in Health webinar series: The NHS landscape presentation.
This webinar identifies the structure of the NHS and its national priorities.
The session will cover the following topics:
Understand the structure of the NHS
Understand the national priorities of the NHS
Recognise the barriers to sale
Facts, figures and views on health and social care: A pack prepared for repor...Nuffield Trust
This presentation was created for reporters looking for key facts, figures and views on health and social care in the run up to the general election in 2015 in the UK. It was compiled by Leonora Merry and references Nuffield Trust research and analysis throughout.
Creating successful partnerships in yorkshire and humberPM Society
The document discusses creating successful partnerships in Yorkshire and Humber through the Yorkshire and Humber Academic Health Science Network (YH AHSN). It outlines the AHSN's large membership network and the challenges in the region including health variations and economic pressures. The AHSN's 2013/14 work programme focuses on improving population health, transforming health services, increasing wealth and research participation through various partnership initiatives. Key to success is emphasizing collaboration, adding value to existing organizations, and closing gaps between industry, higher education and the NHS.
Let us share with you our successes, impacts and performance over the past year. The Innovation Agency is proud to bring you our Annual Report for 2015/16.
This document provides a comparative analysis of primary health care policies in the UK, Australia, and New Zealand since 2000. It summarizes the key policies implemented in each country, including the introduction of primary health organizations and capitation funding in New Zealand, practice-based commissioning and pay-for-performance in the UK, and Medicare reforms and preventative health strategies in Australia. The document concludes that primary health care is better developed in the UK based on metrics like quality of care, access, costs, coordination, and patient satisfaction. This is attributed to the NHS system's greater integration, financial incentives for providers, and focus on chronic disease management and nurse-led care.
The document discusses plans for the Cheshire and Mersey Comprehensive Local Research Network (CLRN) and its transition to the North West Coast CLRN. It outlines objectives to double recruitment, increase commercial study participation, and reduce approval times. It also discusses merging over 100 networks into 15 Local Clinical Research Networks including the North West Coast CLRN covering Cheshire, Mersey, South Cumbria and Lancashire with an £18 million budget. The goal is to simplify structures while maximizing research delivery and protecting national priorities through close working with the Academic Health Science Network.
The document discusses the history and current state of Teaching Health Centers (THCs), which provide primary care medical residency training in community and rural health centers. Key points:
- THCs were established in 2010 under the ACA to expand GME outside of hospitals. There are now 44 THC programs across 21 states.
- THCs receive funding through 2015 from HRSA, but this funding will expire without reauthorization. Current residents may not complete training if funding lapses.
- Legislation has been introduced to extend THC funding for 5 more years, but long-term support is still uncertain. The program shows promise for training more primary care physicians for underserved areas.
Webinar slides: Personal health budgets and mental health: Getting ready and ...In-Control Partnerships
Personal Health Budgets for Mental Health discusses personal health budgets, which allocate NHS resources for individuals to manage their own healthcare. The document summarizes findings from a national pilot program that found personal health budgets improved quality of life and were more cost effective than conventional services. It describes a new mental health demonstrator program to implement personal health budgets sustainably in the NHS. Key challenges include allocating resources to individuals, unlocking money from existing contracts, and achieving necessary culture changes to support more patient choice and control.
The document outlines a 7-step framework for joint working between the NHS, academia, voluntary sectors, social care, and industry for the benefit of patients. The framework involves identifying a common goal, determining if resources can be pooled, investments made, agreements put in place, commitments to delivery, transparency of agreements, returns on investment measured, and tracking outcomes. An example is provided of applying this framework through the Greater Manchester Care and Support Network.
David Buck on improving the allocation of health resources in England The King's Fund
David Buck, Senior Fellow in Public Health and Inequalities at The King’s Fund, explains how health resources are allocated in the English NHS, and how improvements to the process could be made to support a more coherent health and care system.
This document summarizes a presentation about estimating the opportunity costs of local health care expenditures in Scotland. It discusses how spending decisions are made at the margins between least and most cost-effective services currently funded. The study aimed to estimate Scotland's cost-effectiveness threshold using data on marginal services but found too much variation to derive a reliable estimate. Spending decisions were actually driven more by other factors than cost-per-QALY evidence. The mismatch between objectives of the NHS and HTA bodies suggests the threshold does not represent the true opportunity cost of funding decisions.
Martin Bardsley: integration and innovation in healthNuffield Trust
This document summarizes two case studies that used retrospective evaluations of existing administrative data to assess the impact of healthcare interventions. The first case study evaluated the Marie Curie Nursing Service and found it significantly increased home deaths and reduced hospital admissions and costs at end of life. The second case study evaluated eight community interventions under the Partnerships for Older People Projects but found none reduced hospital use as anticipated. Both cases highlighted strengths and limitations of using retrospective evaluations of routine data to assess healthcare interventions.
Malawi Mid-Year Review 2014-2015 Health Sector Overviewmohmalawi
The document summarizes the mid-year review of Malawi's health sector for the period of July-December 2014. It outlines key highlights including a continued focus on maternal, neonatal and child health as well as responding to emergencies like floods, cholera outbreaks, and the Ebola threat. It provides details on health sector financing, performance of health systems and service delivery, and reforms being pursued to improve quality and efficiency. Overall resources for the 2014/15 fiscal year were mapped at MK278.8 billion, with the government contributing 92% of the required funding for the health sector pool.
This presentation provides information on the NHS Working Longer Review and related changes to the NHS pension scheme. The aims are to raise awareness of the review, seek views on involvement in research and a call for evidence, and discuss ensuring organizational views inform the review group report. The review group will examine the impact of working longer for NHS staff due to 2012 pension changes and make recommendations. Related changes will increase the NHS normal pension age to the state pension age starting in 2015. The presentation discusses current pension ages and retirement ages, research findings on extending working lives, and potential risks. It concludes by posing questions on responding to the call for evidence and potential involvement in proposed MRC research.
Matthew Drohan graduated from Penn State University with a B.S. in Biology focusing on genetics and development. He has experience as a research assistant performing biogeochemical analysis of vernal pools and as a biological research analyst conducting market feasibility studies. He has also served as captain of the Penn State men's crew team and held a board officer position for fundraising. He has strong laboratory, data analysis, and communication skills.
The Hellesdon Hospital was put under special measures due to poor clinical outcomes. An investigation found that the Suffolk Mental Health Partnership had major management issues in 2009-2010, leading it to merge with the Norfolk and Waveney Mental Health Foundation Trust in 2012. A service redesign plan proposed in 2012 aimed to cut costs but faced challenges, and the CEO resigned in 2013 as the plan was implemented. In 2015, the Care Quality Commission found patient needs were not always met and care plans outdated, indicating demoralized staff and poor clinical governance.
HTA training - Claire Gorry - July 26th 2016ipposi
This document provides information about the National Centre for Pharmacoeconomics' (NCPE) initiatives to engage patient communities in Ireland. It discusses the NCPE's patient submission template pilot, which allows patient groups to include the patient perspective in healthcare technology assessment decisions. It provides guidance on completing submissions, including focusing on how a new treatment may help address patient needs and improve outcomes compared to current options. Submissions are limited to 6 pages and included in the NCPE's final reports to help inform reimbursement recommendations.
Sarah khan-for-web-improving-mhcc-conference-15 1209.10.153GDR
NHS England is committed to transforming mental health crisis care services in England. There are several policy drivers to improve crisis care, including the Crisis Care Concordat agreement. NHS England will invest in liaison psychiatry services in acute hospitals and plans to reduce the use of police cells as places of safety. The organization also aims to ensure mental health crisis care is integrated into the Urgent and Emergency Care Review. Additionally, NHS England will develop access and waiting time standards for crisis services through national quality improvement efforts.
This document provides an overview and summary of the planning guidance for the NHS in England for 2015/16. It outlines the key priorities and requirements for the coming year which include maintaining performance standards, implementing new models of care, improving prevention, workforce development, digital transformation, and driving efficiency. Local areas are encouraged to develop plans that align commissioner and provider budgets and activity in line with the priorities of the Five Year Forward View.
The document summarizes the key themes of the NHS 5 Year Forward View plan. It outlines the plan's vision for new models of integrated care focused on populations of 50,000 people. The plan acknowledges an estimated annual funding gap of £30 billion by 2020/21 for the NHS and the need for efficiency savings and increased funding. It also emphasizes the importance of prevention, personalization, technology, and social determinants of health for a sustainable healthcare system.
The document summarizes the work of Academic Health Science Networks (AHSNs) in the UK. It discusses how AHSNs connect the NHS, academics, researchers and industry to spread innovation, improve health, and generate economic growth. Specifically, it provides examples of how AHSNs are:
1) Supporting innovation and enterprise by connecting small businesses with the NHS to drive economic growth and improve patient care.
2) Spreading best practice by connecting clinicians to share innovations and drive improvement across health systems.
3) Creating an infrastructure to enable the development, adoption, and diffusion of innovations by establishing partnerships and funding facilities.
Master slide deck from the Excel in Health webinar series: The NHS landscape presentation.
This webinar identifies the structure of the NHS and its national priorities.
The session will cover the following topics:
Understand the structure of the NHS
Understand the national priorities of the NHS
Recognise the barriers to sale
Facts, figures and views on health and social care: A pack prepared for repor...Nuffield Trust
This presentation was created for reporters looking for key facts, figures and views on health and social care in the run up to the general election in 2015 in the UK. It was compiled by Leonora Merry and references Nuffield Trust research and analysis throughout.
Creating successful partnerships in yorkshire and humberPM Society
The document discusses creating successful partnerships in Yorkshire and Humber through the Yorkshire and Humber Academic Health Science Network (YH AHSN). It outlines the AHSN's large membership network and the challenges in the region including health variations and economic pressures. The AHSN's 2013/14 work programme focuses on improving population health, transforming health services, increasing wealth and research participation through various partnership initiatives. Key to success is emphasizing collaboration, adding value to existing organizations, and closing gaps between industry, higher education and the NHS.
Let us share with you our successes, impacts and performance over the past year. The Innovation Agency is proud to bring you our Annual Report for 2015/16.
This document provides a comparative analysis of primary health care policies in the UK, Australia, and New Zealand since 2000. It summarizes the key policies implemented in each country, including the introduction of primary health organizations and capitation funding in New Zealand, practice-based commissioning and pay-for-performance in the UK, and Medicare reforms and preventative health strategies in Australia. The document concludes that primary health care is better developed in the UK based on metrics like quality of care, access, costs, coordination, and patient satisfaction. This is attributed to the NHS system's greater integration, financial incentives for providers, and focus on chronic disease management and nurse-led care.
The document discusses plans for the Cheshire and Mersey Comprehensive Local Research Network (CLRN) and its transition to the North West Coast CLRN. It outlines objectives to double recruitment, increase commercial study participation, and reduce approval times. It also discusses merging over 100 networks into 15 Local Clinical Research Networks including the North West Coast CLRN covering Cheshire, Mersey, South Cumbria and Lancashire with an £18 million budget. The goal is to simplify structures while maximizing research delivery and protecting national priorities through close working with the Academic Health Science Network.
The document discusses the history and current state of Teaching Health Centers (THCs), which provide primary care medical residency training in community and rural health centers. Key points:
- THCs were established in 2010 under the ACA to expand GME outside of hospitals. There are now 44 THC programs across 21 states.
- THCs receive funding through 2015 from HRSA, but this funding will expire without reauthorization. Current residents may not complete training if funding lapses.
- Legislation has been introduced to extend THC funding for 5 more years, but long-term support is still uncertain. The program shows promise for training more primary care physicians for underserved areas.
Webinar slides: Personal health budgets and mental health: Getting ready and ...In-Control Partnerships
Personal Health Budgets for Mental Health discusses personal health budgets, which allocate NHS resources for individuals to manage their own healthcare. The document summarizes findings from a national pilot program that found personal health budgets improved quality of life and were more cost effective than conventional services. It describes a new mental health demonstrator program to implement personal health budgets sustainably in the NHS. Key challenges include allocating resources to individuals, unlocking money from existing contracts, and achieving necessary culture changes to support more patient choice and control.
The document outlines a 7-step framework for joint working between the NHS, academia, voluntary sectors, social care, and industry for the benefit of patients. The framework involves identifying a common goal, determining if resources can be pooled, investments made, agreements put in place, commitments to delivery, transparency of agreements, returns on investment measured, and tracking outcomes. An example is provided of applying this framework through the Greater Manchester Care and Support Network.
David Buck on improving the allocation of health resources in England The King's Fund
David Buck, Senior Fellow in Public Health and Inequalities at The King’s Fund, explains how health resources are allocated in the English NHS, and how improvements to the process could be made to support a more coherent health and care system.
This document summarizes a presentation about estimating the opportunity costs of local health care expenditures in Scotland. It discusses how spending decisions are made at the margins between least and most cost-effective services currently funded. The study aimed to estimate Scotland's cost-effectiveness threshold using data on marginal services but found too much variation to derive a reliable estimate. Spending decisions were actually driven more by other factors than cost-per-QALY evidence. The mismatch between objectives of the NHS and HTA bodies suggests the threshold does not represent the true opportunity cost of funding decisions.
Martin Bardsley: integration and innovation in healthNuffield Trust
This document summarizes two case studies that used retrospective evaluations of existing administrative data to assess the impact of healthcare interventions. The first case study evaluated the Marie Curie Nursing Service and found it significantly increased home deaths and reduced hospital admissions and costs at end of life. The second case study evaluated eight community interventions under the Partnerships for Older People Projects but found none reduced hospital use as anticipated. Both cases highlighted strengths and limitations of using retrospective evaluations of routine data to assess healthcare interventions.
Malawi Mid-Year Review 2014-2015 Health Sector Overviewmohmalawi
The document summarizes the mid-year review of Malawi's health sector for the period of July-December 2014. It outlines key highlights including a continued focus on maternal, neonatal and child health as well as responding to emergencies like floods, cholera outbreaks, and the Ebola threat. It provides details on health sector financing, performance of health systems and service delivery, and reforms being pursued to improve quality and efficiency. Overall resources for the 2014/15 fiscal year were mapped at MK278.8 billion, with the government contributing 92% of the required funding for the health sector pool.
This presentation provides information on the NHS Working Longer Review and related changes to the NHS pension scheme. The aims are to raise awareness of the review, seek views on involvement in research and a call for evidence, and discuss ensuring organizational views inform the review group report. The review group will examine the impact of working longer for NHS staff due to 2012 pension changes and make recommendations. Related changes will increase the NHS normal pension age to the state pension age starting in 2015. The presentation discusses current pension ages and retirement ages, research findings on extending working lives, and potential risks. It concludes by posing questions on responding to the call for evidence and potential involvement in proposed MRC research.
Matthew Drohan graduated from Penn State University with a B.S. in Biology focusing on genetics and development. He has experience as a research assistant performing biogeochemical analysis of vernal pools and as a biological research analyst conducting market feasibility studies. He has also served as captain of the Penn State men's crew team and held a board officer position for fundraising. He has strong laboratory, data analysis, and communication skills.
The National Eligibility cum Entrance Test (NEET-UG) for admission to MBBS and BDS programs will be held on May 5, 2013. With less than a week remaining, candidates should thoroughly review concepts from CBSE textbooks as approximately 20% of questions will cover practical applications. Students are advised to focus on revising concepts they have already learned rather than trying to learn new topics. In the remaining days before the exam, students should take practice tests to boost confidence and manage time effectively during the exam, which will contain 180 questions across physics, chemistry, and biology sections within a 3 hour time limit. There will be negative marking for incorrect answers, so students must answer carefully.
B orthognathic surgery results George VilosGeorge Vilos
This document summarizes several orthognathic surgery cases performed by Dr. George A. Vilos. The surgeries included:
1) A left condylectomy, LeFort I advancement, genioplasty with asymmetric reduction, and left inferior body ostectomy.
2) Two piece LeFort I impaction and transverse widening with cosmetic rhinoplasty.
3) LeFort I impaction.
4) LeFort I, bilateral sagittal split osteotomy, and genioplasty.
5) Two piece LeFort I with impaction on the right and downgraft on the left, along with bilateral sagittal split osteotomy advancement.
6
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help boost feelings of calmness, happiness and focus.
El documento describe el sistema nervioso central y periférico. Explica que el sistema nervioso central incluye el cerebro, cerebelo y médula espinal, y que está conectado al sistema nervioso periférico de nervios. Describe las tres funciones básicas del sistema nervioso como sensitiva, integradora y motora, y explica que las neuronas transmiten señales entre los diferentes sistemas nerviosos.
La reproducción humana involucra los aparatos reproductores masculino y femenino. En la mujer, si no hay fecundación del óvulo se produce la menstruación, pero si hay fecundación se produce el embarazo, el cual dura nueve meses y termina con el parto, ya sea natural a través de la vagina o mediante una cesárea si es necesaria.
Este documento describe los diferentes tipos de ecosistemas, incluyendo acuáticos (agua dulce y salada), terrestres (desiertos, selvas y praderas), y aéreos. También explica que los ecosistemas son unidades ecológicas compuestas por factores físicos, químicos y seres vivos, y que sus interacciones son diversas. Además, define la biosfera como el conjunto de seres vivos de la Tierra y sus relaciones. Finalmente, señala que la mayoría de los cambios en los e
This document outlines the syllabus for a Business 101.1 class at NYU ITP. The syllabus covers topics like forming business models, customer development, interviewing customers, defining value propositions, analyzing key resources and activities, planning minimum viable products, testing assumptions, and establishing customer relationships and channels. It provides an overview of the concepts and frameworks that will be taught over the course of the class, including the business model canvas, customer funnels, lifetime value vs. cost of customer acquisition, net promoter score, and traction channels.
Leading the library of the future: w(h)ither technical services?Keith Webster
The document discusses the changing role of technical services in libraries. It notes that technical services used to consume a large portion of library resources to acquire, catalog, and process physical materials, but that role is now obsolete with digital formats and universal access. The advent of electronic publishing and new discovery tools have made the traditional organizational structure focused on technical services unnecessary. This change has led to a dramatic improvement in library services over the past decade as libraries shift resources from technical processing to more direct user services.
El documento analiza el contexto actual de la pornografía y sus diferentes manifestaciones. La pornografía se ha difundido ampliamente a través de los medios de comunicación, internet, películas, literatura, música, entre otros. Existe una delgada línea entre la pornografía y el erotismo, siendo la pornografía una degradación del erotismo al separar el sexo del amor y comercializarlo. La pornografía puede ser blanda o dura dependiendo de su grado de explicitud.
HISTORY: Indian, Chinese, Japanese Architecture ArchiEducPH
The document discusses Indian, Chinese, and Japanese architecture. For Indian architecture, it describes the axis mundi concept and how it is represented in stupas through elements like the vedika, torana, anda, and chattras. For China, it mentions ancestor worship and Confucian philosophy. For Japan, it outlines the Seven Great Temples of Nara and describes some of their key architectural features. It also discusses the Zen style and shinbutsu-shugo, the syncretism of Buddhism and Shinto.
Delivering clinical and financial sustainability, pop up uni, 2 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Delivering clinical and financial sustainability across a £6bn health economy...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
The document outlines the challenges facing general practice in the UK, including increased workload, an aging population with more complex needs, and declining GP morale. It then summarizes the General Practice Forward View, which includes £2.4 billion in additional annual funding by 2020-21, expanding the primary care workforce by 5,000 doctors and 5,000 other staff, reducing practice burdens, improving technology and infrastructure, and redesigning care. The key actions focus on accelerating funding, expanding and supporting staffing, reducing burdens, improving the estate and technology, and providing improvement support to practices.
- Slit lamp examination (including fundus)
- Perform biometry and focimetry
- Decide appropriateness for surgery
- Perform auto-refraction
- Discuss desired post-operative refractive status
with the patient (including current type of
spectacle correction) to enable the choice of lens
implant
- Perform ECG and blood tests
- Identify 2nd eye surgery where appropriate
Benefits
- reduces duplication of tasks
- reduces waiting time for patients
- frees up nursing time for other duties
- ensures all key tasks are completed in one visit
- improves patient experience
- reduces overall time in clinic
09
General Practice Transformation Champions: Transformation of Primary CareNHS England
This document summarizes actions NHS England is taking to address challenges in primary care, such as workforce shortages and increasing workload pressures, in response to perceptions that not enough is being done. It outlines numerous initiatives to expand the primary care workforce and their skills, increase funding for general practice, support practices in working at scale, empower patients to self-care, and utilize technology. It acknowledges the GP Forward View is only the beginning and a long-term vision will be needed to fully optimize the role of general practice within the NHS.
This document discusses international medical training partnerships between the UK and other countries. It provides the example of a successful partnership between Sherwood Forest Hospitals NHS Trust (SFHT) in the UK and the Postgraduate Institute of Medicine (PGIM) in Sri Lanka. Through this partnership:
- SFHT provides 6-month training placements for Sri Lankan specialist trainees at senior house officer and specialist registrar levels, with educational and pastoral support.
- Trainees gain experience in their specialty as well as general internal medicine. They are integrated into the local educational programs and assessment processes.
- The partnership model has been beneficial for trainees, trainers, and the partner institutions in Sri Lanka and the UK. It
This newsletter provides updates on education, mentorship, and clinical placements within Central London Community Healthcare NHS Trust. Key points include:
- The trust manages a mentor register and staff should ensure their records are up to date. Mentors must complete updates and triennial reviews.
- The trust supports various education programs including a Care Certificate program, apprenticeships, and a new fast track program for newly qualified nurses.
- The trust partners with universities to provide clinical placements for nursing and AHPS students, hosting 374 nursing students and 489 AHPS weeks of placements in 2015-2016. Audits of placement areas are conducted every two years.
C_inetpubwwwrootmedicalcemUploaddocumentzCEM8691-RCEM Scotland & Scottish Gov...tim parke
This document provides guidance from the Scottish Government on developing standardized processes to manage emergency department capacity and avoid crowding. It outlines six essential actions for improving unscheduled care, including clinically focused management, capacity and patient flow management, and ensuring patients are cared for in their own homes when possible. The guidance recommends developing an escalation framework to proactively manage capacity and eliminate crowding through early notification, clear decision making, and escalation steps. Implementing this guidance could help standardize capacity management across NHS Scotland and improve patient safety, quality of care and flow.
Midlands and East GP Forward View update event May 2017NHS England
A presentation from the GP Forward View update event in May 2017 for Midlands and East, giving the latest information on what the Forward View is delivering.
The document discusses challenges facing the NHS in England and reforms proposed to address them. It outlines population aging and rising chronic disease prevalence as challenges. The Five Year Forward View proposes integrated primary and community care networks and greater emphasis on prevention. However, public health budgets are being cut even as needs rise. The success of reforms will depend on evaluation of outcomes, efficiency, experiences and the impact of funding changes.
The document provides an overview of the National End of Life Care Update in the UK by Prof Bee Wee. It discusses the NHS Long Term Plan's focus on personalizing end of life care and introducing proactive care planning for those in their last year of life. It also outlines new service models for older people, children, and young people. The document summarizes reforms to the GP Quality and Outcomes Framework to improve early identification of those nearing end of life. Priorities and approaches for 2019/20 are presented, including responding to challenges in end of life care.
Connected Health & Me - Prof George Crooks - Nov 24th 2014ipposi
The document discusses connected health and telehealth initiatives in Scotland. It provides context on Scotland's population of 5.3 million people and devolved health system with £12 billion in annual NHS funding. The vision by 2020 is for integrated health and social care focused on prevention, self-management, and home-based or community care when possible. Key drivers for change include an aging population, chronic conditions, workforce shortages, and financial unsustainability. The Scottish Centre for Telehealth and Telecare coordinates national telehealth and telecare programs to help manage demand on the NHS and deliver clinical services more efficiently using technologies like telehealth.
BPF-Quality-Buildings-Quality-Care-Nov-15-web_0Karen West
This document discusses how investment in healthcare real estate can contribute to improved patient care and staff wellbeing. It finds that services provided from new healthcare premises are three to four times more likely to receive an "Outstanding" rating from regulators. Modern facilities are also safer for patients, with 30% lower fall rates and 10% lower overall patient harm in new hospitals and care homes. Continuous investment in flexible, future-proof buildings is critical to ensure these benefits are realized across the entire national healthcare portfolio. Doing so would benefit both patients and healthcare professionals.
The document summarizes the winners of the 2011 HSJ Efficiency Awards. It provides details about the winning projects from various NHS trusts that demonstrated successful efficiency initiatives. The first winner summarized is the University Hospital of South Manchester Foundation Trust, which launched a communications campaign called "High quality care costs less" to engage staff and exceed its savings targets. The second winner summarized is Gloucestershire Hospitals Foundation Trust, which redesigned its unscheduled care pathway and improved patient outcomes while achieving significant cost savings.
P1-Healthcare and RD Landscape in Singapore.pptxtrilok bavishi
This document provides an overview of the healthcare system and research & development landscape in Singapore. It describes Singapore's highly developed healthcare system, current challenges around an aging population and staffing shortages, and priorities like strengthening the sector and reducing inequalities. It also discusses Singapore's healthcare research strategy, innovation process, and SWOT analysis of the R&D landscape. Key players in Singapore's healthcare industry are listed in an appendix.
Ian Legg has extensive experience managing departments and implementing changes in the NHS. He has held several interim manager roles where he improved department operations and finances. His qualifications include a BSc in Microbiology, fellowship in Biomedical Science, and certificates in Health Service Management, Education, and Project Management. Legg has skills in change management, process improvement, workforce development, financial management, and health/social care integration from national projects and manager roles spanning multiple hospital sites.
This document is Young Fine Gael's pre-budget submission for 2016. It proposes several measures to address issues affecting young people in Ireland such as unemployment, mental health, and third level accommodation. The key recommendations are to increase funding for mental health services, address the lack of student accommodation through incentives for student housing and tax relief for purpose-built accommodation, establish an independent budgetary office to cost opposition proposals, increase employment among graduates through mandatory work placements, standardize the minimum wage, remove certain business taxes, and introduce a recycling levy on bottles and cans. The submission aims to provide "a bright future for young Ireland."
Training and Up-skilling the Workforce to Deliver Effective 7-DayServicesNHS Improving Quality
Training and Up-skilling the Workforce to Deliver Effective 7-DayServices – Improving Access and Quality Across the NHS. Presentation given by Patrick Mitchell, Health Education England at the Improving access to seven day services event, Southampton 25 March 2015.
The document provides a commercial update for May 2016, including:
- Updates on programmes like sustainability and transformation partnerships, vanguards, and the Five Year Forward View.
- Information on changes to procurement regulations and the standard NHS contract for 2016/17.
- New features like "Our Insights" focusing on myths around competitive dialogue and submitting compliant tenders.
- Sections with commissioner updates, provider updates, and notices about procurement and contracts.
1. July 2015
A blueprint for Scottish general practice
A strategy for a safe, secure and strong
general practice in Scotland
2. General practice is central to the future of the NHS in
Scotland. This paper sets out a blueprint to reverse the
impacts of the increasing problems of workload and
recruitment on the ability of GPs to deliver excellent patient
care. These problems have become ever more apparent
over the last six months. The Royal College of General
Practitioners Scotland (RCGP Scotland) has been warning
for a year and a half now — through our Put patients first:
Back general practice campaign — that rising workloads,
a shortage of GPs and declining resources are putting
intolerable pressure on local practices and posing a threat
to patient care. As many people’s first point of contact with
the NHS, around 90% of patient interaction is with primary
care services. General practice is the cornerstone of
primary care, with Scottish GP surgery teams carrying out
an estimated 24.2 million consultations each year — an
11% rise over ten years1
.
At the same time, the share of NHS funding spent
on general practice in Scotland has been falling year
on year. The GP percentage has fallen from 9.8% in
2005/06 to a record low of 7.8% in 2012/13. This drop
has led to a real terms cumulative loss of investment of
£1.1 billion into Scottish general practice compared to a
scenario where funding had remained at 9.8%. General
practice is a cost-effective part of the healthcare system
in which to invest as it is more economical than other
parts of the system and can prevent worsening of
patient outcomes (see Box 2 page10). However, it will
not be able to deliver positive changes in the short,
medium and long-term without significant investment to
increase the size of the workforce.
RCGP Scotland has warmly welcomed and participates
in the review of out of hours primary care services
chaired by Professor Sir Lewis Ritchie and due to
report in September 2015. It is clear that many of
the measures called for in this document will impact
positively on out of hours care. This document in no
way seeks to pre-empt the review but recognises that
many of the constructive steps called for here will aid
in the provision of appropriate out of hours care. The
RCGP Scotland Green Light statement of February
2015 offers further information on the College’s
position but it bears repetition that the College sees
it as essential that GPs remain a central part of the
service to ensure safe, holistic patient care. Out of
hours care is an integral part of general practice.
This document builds on the solid foundations provided
by earlier work from the Royal College of General
Practitioners. Among others, RCGP Scotland’s The
Essence of General Practice2
, Developing a Quality
Framework for General Practice in Scotland3
, the Time
To Care health inequalities report4
and The Future
of General Practice in Scotland: A Vision5
have all
contributed to the thinking behind this blueprint. It is
intended as one for discussion with all stakeholders,
not least Scottish Government. Of course, any
changes undertaken must be evaluated appropriately
and this will require robust general practice academic
input, such as that provided by the Scottish School of
Primary Care. Changes must clearly also align with
the developing work on integration and on multiple
morbidities.
Introduction
A blueprint for Scottish general practice
2
3. In November 2014, the Scottish Government announced
an additional £40 million investment for general
practice and primary care in Scotland, to be used
in the 2015/16 financial year. However, since this
announcement there have been further developments
and the Cabinet Secretary has recently indicated
her intention that such a fund be spread
over three years. We urgently need a clear
strategy from the Scottish Government for investing in
Scottish general practice, ensuring that funding reaches
general practice in the coming year but also putting GP
services on a more sustainable footing for the long term
so that they may deliver effective, quality care to patients
appropriate to their needs 24 hours a day, seven
days a week. This document sets out a strategy
towards this.
JuLY 2015
3
Building
a properly
funded general
practice
hub
Ongoing,
sustained
investment
in general
practice
Investing
in
infrastructure
Promoting
integrated
care
Expanding
the wider
primary care
workforce
The
2020 Vision of
an integrated
Health and
Social Care
system
Expanding
the number
of GPs
4. A blueprint for ScottiSh generAl prActice
4
1. Expanding the number of GPs
Set a clear objective to increase the number of Whole
Time Equivalent GPs in Scotland. RCGP Scotland
is calling for the expansion of the GP workforce by 740
general practitioners in Scotland by 2020. This figure
is the midpoint between the previous range of WTE
estimates produced by RCGP in April 2015. This range
was based on reaching and maintaining the 2009 level
of GP coverage and projecting forward using Office
of National Statistics predicted population growth.
The Scottish Government should work with RCGP
Scotland and NHS Education for Scotland (NES) and
ensure progress against this aim is closely monitored.
This strand of work should include involving university
departments and foundation schools with the aim of
improving and promoting recruitment to meet the target of
at least 50% of medical students entering general practice.
Launch a high profile marketing campaign to
promote general practice as a career. The campaign
run by NES in 2015 should be reviewed with the aim
●
The Scottish Government’s NHS Information Services
Division (ISD) released a Primary Care Workforce Survey in
2013. Its Publication Summary reported that ‘The estimated
Whole Time Equivalent (WTE) number of GPs in post in
Scottish general practices (excluding Specialist Trainees) at
31 January 2013 was 3,735. This is only a little higher than
the estimate of 3,700 generated from a previous survey run
in 2009. ... The results of this survey suggest that the WTE
number has been fairly static over the past few years.’ This
is simply not enough to meet the changing needs of patients.
One in five GPs in Scotland is aged over 55 and, therefore,
20% of the GP workforce could feasibly and naturally retire
over the next five years. This figure is bolstered by the
alarming findings of the recent British Medical Association
(BMA) survey, published in April, which suggests that one in
three Scottish GPs were hoping to retire within the next five
years. We need greater investment in GP workforce capacity
so that Scotland can care for its growing, ageing population
at home, in a homely setting and in the community.
Whatever the shape of the 2017 GMS contract negotiations,
Scotland urgently needs a package of measures backed
by resources to increase the number of GPs, including
encouraging more doctors to choose general practice as
a career, doing more to retain our current GP workforce,
working to prevent GPs retiring when they are still able to
provide an excellent service to patients, and making it easier
for those who have left the profession to return to practice.
We urge the Scottish Government to take the following
actions to increase the GP workforce:
of setting up a fully resourced marketing campaign to
encourage foundation doctors and medical students
to choose general practice as a career. This should
include dedicated funding for recruitment roadshows to
showcase general practice as a career to foundation
doctors and medical students across Scotland.
Incentives to attract new doctors into general
practice, particularly in under-doctored areas.
A further package of enhanced, targeted, financial
incentives should be developed to encourage medical
graduates to train and practise as GPs in currently
under-doctored and deprived areas. These incentives
could include helping graduates to pay off their student
loans if they agree to practise in selected areas — an
approach that has already been pioneered in New
Zealand and is currently being explored in England.
A large scale campaign to promote the national GP
Induction and Returner Programmes will be important
in boosting the workforce in Scotland. Scotland has
had an established GP Returner Scheme delivered by
NES for many years and regional Health Boards have
provided inductions where appropriate. This requires
further publicity as uptake of these schemes has been
variable with an average of 7.5 GPs per year over the
past ten years entering the Returner scheme. It is now
known that some 259 GPs under the age of 50 have
left Scottish Performers Lists in the last five years, of
which 166 were aged less than 40 years old. The NES
GP Directors must be commended for their review
of the programmes in Scotland and for upgrading
the NES website to provide an easily accessible and
comprehensive resource to signpost and support GPs
into the workforce. However, further assurance of
recurring funding and resource is required to ensure a
sufficient boost to the number of trained GPs who are
able to return to general practice. These programmes
should be available for trained GPs from a variety of
backgrounds including Scottish GPs who have had
career breaks and those who wish to join the Scottish
GP workforce from both within and outside the uK.
Increased investment in the national retainer
programme, including a review to identify the most
effective measures to encourage experienced GPs
to remain within practice. Scotland already has a
successful and quality assured retainer scheme through
which GP retainers are well supported. However, GP
practices need further support and this scheme should
have its funding increased with incentives designed to
encourage more GP practices to take on GP retainers.
●
●
●
●
5. With GPs facing immense pressure due to rising
workloads and constrained finances, morale in Scottish
general practice is currently very low. A recent survey
of GPs found that over half (54%) feel their current
workload is unmanageable or unsustainable6
. The
significant contribution of other members of the primary
care team in delivering high quality patient care in the
primary care setting cannot be ignored. Whilst other
health professionals can never be a direct replacement
for general practitioners, and while the role of GPs in
being the first point of patient contact, in co-ordinating
comprehensive care and in providing continuity of care,
must be protected — the role the wider primary care
workforce has to play in delivering services is vital.
There are significant challenges facing other healthcare
professionals. For example, community nurses are
facing significant retirement challenges. Almost 50%
of NHS community nurses in NHS Scotland are aged
50 years or older. This means that the recruitment
challenge to safeguard services against this retirement
‘cliff’ will be extremely pronounced over the next five
years7
. Strengthening the capacity and capability of other
healthcare professionals in general practices is essential
to improve the quality of healthcare services in the
community.
To expand the wider primary care workforce to support
general practice, the Scottish Government could enact
the following:
2. Expanding the wider primary care workforce
to support general practice
JuLY 2015
with NES to establish how the role of community
and practice nurses can be promoted in order to
boost numbers in Scotland.
Promote the role of practice-based and community
pharmacists. Both practice-based and community
pharmacists are uniquely placed to work with GPs
to improve patient care and safety, and can play an
important role in the long-term management of patients
with chronic disease. In March, the RCGP and Royal
Pharmaceutical Society (RPS) issued a joint statement,
RCGP and RPS Policy Statement on GP Practice
Based Pharmacists, highlighting the important role that
practice-based pharmacists can have based in general
practices8
. There should be investment in recruitment
and training of pharmacists based in general practice
who would be of considerable value in reviewing
patients’ medication, managing polypharmacy,
managing medication issues for the housebound within
the newly integrated health and social care teams,
linking effectively with community pharmacists and
medicines reconciliation across the interface, all with
significant benefit to patient safety. This could improve
care, save the NHS a significant amount of money and
alleviate pressures on GPs.
The RCGP and RPS also worked together regarding
community pharmacists via their statement, Breaking
down the barriers — how community pharmacists
and GPs can work together to improve patient
care9
. This sets out recommendations for benefits
to patients in improving liaison between community
pharmacists and general practitioners. In response
to Prescription for Excellence10
, there have been
a number of initiatives across Scotland. Current
projects regarding collaborative working with
community pharmacists include:
●
The Highland Community Pharmacy project where
the objective is to develop decision support between
community pharmacists and local GP practices.
Healthcare Improvement Scotland’s National Patient
Safety Programme in Primary Care, which includes
the Pharmacy in Primary Care Collaborative, which
aims to enhance communications between GPs and
Community Pharmacists in rural and urban settings.
●
5
Provide funding to enhance community nursing
and enable practices to recruit more practice
nurses. Community and practice nurses have a vital
role to play in delivering high quality patient care in
the community. Boosting the number of community
and practice nurses and widening their remit to take
on additional tasks will help free up time for GPs to
spend with patients with complex needs. NES has
a General Practice Nursing Programme and it is
currently examining ways in which to boost take
up. An expansion of that programme should allow
more places to be provided. In order to encourage
more nurses to become community or practice
nurses, national training standards and clear career
pathways for these nurses need to be developed.
RCGP Scotland would welcome a joint programme
●
●
6. A blueprint for Scottish general practice
The Integration of Health and Social Care seeks to
improve care for patients as well as ensuring GP services
are efficient and effective. RCGP Scotland believes that
the integration of care should be primary care led and
offered by multi-professional teams to deliver the best
possible health outcomes. Care planning for those with
complex conditions, redesigning services to provide
more services in the community and the establishment
of GP clusters are vital to achieving better outcomes for
patients. In Scotland, general practitioners are keen to
develop new models of care, in particular GP clusters,
which would allow skills and expertise to be shared across
practices. The following suggestions are forwarded in
the expectation that successful ongoing work, such as
Healthcare Improvement Scotland (HIS) and RCGP
Scotland’s Developing a Quality Framework for General
Practice in Scotland11
, and the National Clinical Lead
for Self Management and Health Literacy, Dr Graham
Kramer’s work on supported self management and the
House of Care development, will continue to be supported
and furthered.
We call on the Scottish Government to take the following
actions so that GPs may lead the development of new
integrated models of patient care:
3. Giving GPs the tools to lead the development
of new integrated models of patient care
●
●
6
Establishing a sustained package of support
and practical advice which GPs can access to
help them develop new models of care. Whilst
individual practices are excellent at developing
innovations for their specific localities, the system
has challenges in testing and spreading these
innovations to other general practices and the
aforementioned Developing a Quality Framework
for General Practice in Scotland’s concentration on
quality improvement has sought to mitigate against
these difficulties. In order to support the development
and replication of good practice, support packages
which provide practical implementation advice and
funding should be made available.
Ensuring that patient centred care is hardwired
into emerging new models by building on the
strengths of general practice. The doctor-patient
relationship must be protected. In the context of
rising levels of multiple morbidity, these new models
will need to move away from the traditional NHS
focus on single-disease pathways and individual
episodes of care. It is vital, therefore, that these
emerging models build on the strengths of general
practice, including the ‘local’ nature of GP services,
their generalist scope, the continuity of care they
provide to individuals and families and the population-
level perspective they are able to take through
the registered patient list. Patient feedback and
participation should be central to the development
of any new model. RCGP Scotland will, for its part,
continue to seek the input and guidance of its Patient
Partnership in Practice (P3) group and others. The
RCGP has developed five tests (see Box 1 page 7)
that we believe all new models of care should meet.
● Enable RCGP Scotland, NES and the Scottish
Social Services Council (SSSC) to develop general
practitioners’ leadership skills to work effectively
at locality level to implement the vision and values of
integration.
7. JuLY 2015
Box 1. RCGP Scotland’s five tests of new
integrated care:
Proposed models of integrated care should:
Ensure community-based services are led by
community-based clinicians with a person-centred
perspective.
underpin safe patient care by ensuring that GPs
can continue to act as independent advocates for
their patients, with the emphasis on the person not
the institution.
Be person focused, responding to the needs of
the individual and protecting them from over-
medicalisation, with general practitioners working
with specialists to contribute to the holistic care of
the individual.
Develop existing structures and resources to work
in an increasingly co-operative way, recognising
that primary care is a network of providers and
requires a network literacy in its management, with
the IT to support this.
Ensure that general practice and primary care
funding is sufficient to meet their unique and
vital role in delivering person centred care, with
investment in robust evaluation of new models of
integrated care.
1.
2.
3.
7
4.
5.
●
●
Setting aside specific funding to help embed care
and support planning in general practice for those
patients who would benefit most — particularly those
living with long term conditions. There is widespread
agreement that care and support planning — led by
teams of professionals working with patients and their
carers in the community — is effective in helping people
to take more control over their health and to stay well.
The current ongoing work on the House of Care model is
an excellent example of this. However, these teams need
practical support and training in order to scale up the use
of care and support planning across Scotland, and there
is a need in particular for training (across disciplines) in
this area to be developed and promoted. Further support
for general practice to develop strong and effective
links with the Health and Social Care Alliance Scotland
(the ALLIANCE), for example through the placement of
Community Links Practitioners in appropriate practices, is
crucial in developing integration of the services which will
facilitate self management.
Introduce an innovation allowance to allow GPs to
undertake service development. One of the largest
barriers to innovation across GP services is the lack of
time that GPs have to consider service improvement.
Daily workload pressures are a significant challenge to
driving advances in patient care. unlike secondary care,
practices do not have the benefit of staff members who
can focus solely on quality improvement. An innovation
allowance to protect GP time would enable more GPs to
focus on improvement in addition to delivery, therefore
placing them in a position to drive forward development
in GP practices and clusters. GPs will need the
assurance that funding for this work will continue in
some form in the proposed new contract for 2017.
8. ●
8
4. Investing in general practice’s infrastructure
Improving GP premises. Many GPs feel that their
premises are not fit for patient care. Surgeries are
sometimes too small to cope with a growing number of
patients; some premises need upgrading and in certain
cases, brand new premises are needed. RCGP Scotland
is calling for a review of current premises in order to
determine the number of surgeries which need upgrading
or expanding. In addition, possible sharing of premises
with other primary care health providers and voluntary
sector organisations could be explored as one possible
solution to resolving the current situation facing many GP
premises.
In the Chancellor of the Exchequer’s Autumn Statement
of 2014, £1.1 billion funds were raised from fines
collected by the Financial Conduct Authority13
. If, as
announced, these funds are directed at the NHS in
England, that additional spend generates £123 million in
additional funding for the Scottish Government14
.
In England, the £1 billion allocated will be used to fund
advanced care in GP practices over four years (i.e.
£250 million per annum)15
. Comparably, the Scottish
Government should pledge either £24.6 million per year
over five years or £30.8 million per annum over four
●
In the 2014 British Medical Association GP Committee
Premises Survey of 4,720 GP premises, nearly 53.1%
of respondents stated that there had been no significant
refurbishments or developments to their premises within
the last ten years. Furthermore, the same survey found that
38.9% of practices felt that their premises weren’t adequate
for the provision of general practice services and 61.6%
felt that lack of space in their premises was a barrier to
GP education and/or training12
. Lack of physical space is
preventing some practices from expanding the services they
offer to their local communities, and the development of new
integrated services is likely to require investment in new
premises.
As well as funding for premises, there is an urgent need to
invest in IT infrastructure in general practice, to ensure that
practices are able to offer basic services such as online
booking to patients.
We urge the Scottish Government to take the following
actions to invest in general practice infrastructure:
years for the expansion, redevelopment and building of
new premises in Scotland, following a thorough review.
Invest in general practice IT services. Practices are
crippled by the current level of IT systems, including
those which feed into general practice from other
services such as secondary care, and the inability to
link effectively with the systems of other healthcare
professionals in primary care, in particular Community
Nursing colleagues. Frequent ‘crashing’ of systems
stunts day-to-day operations in practice and connectivity
in certain areas of Scotland remains an unsolved
problem. This is a critical component of the quality
agenda.
With regard to specific, basic online services, RCGP
Scotland and Scottish Government suggested five years
ago that improvements could be made by developing
practice websites and other online tools, including online
appointment booking.
In addition to the resource required to address the
significant IT challenges, RCGP Scotland is therefore
also calling for an increase in investment in online
services over the next five years of over £500,000. At a
basic level, this investment could pay for the setting up
and running of websites for a further one third of the
GP surgeries across the country. It could cost £312,000
per annum to reimburse all practices for a standard GP
website.
The Scottish Government could work with Health
Boards to remove any impediments to developing
the full potential of web based patient-to-general
practice communications. This would include online
appointment setting, repeat prescriptions and other
online GP services for the public. However, it should be
remembered that this is not the right option for every
patient hoping to access general practice.
Invest in better access to diagnostic technology in
general practice. Providing more care in the community
and avoiding unnecessary hospital admissions could be
driven by facilitating more diagnostic tests conducted
in GP practices. The Scottish NHS should establish
a separate taskforce to investigate the potential
opportunities for community diagnostics.
●
●
●
●
A blueprint for Scottish general practice
9. The Scottish Government’s announcement to provide a
Primary Care Fund in the current financial year is a first
step in addressing some of the concerns currently facing
general practice. However, since its announcement there
has been little clarity on how this funding will be spent.
The government should use this fund as a starting point
for a continued and sustained shift in investment towards
the 11% called for by the RCGP’s Put patients first: Back
general practice campaign.
Such a shift in funding would enable GPs to improve
care for all patients — by tackling rising waiting times,
improving continuity of care and supporting those with
the most complex needs. Last year, over the course of
just a few months, more than 330,000 people signed a
5. Ongoing, sustained investment in general practice
JuLY 2015
9
petition calling for a larger proportion of NHS funding to be
spent on general practice16
. March 2014 polling conducted
by ComRes found that 61% of Scottish adults would
support the majority of additional funding for primary care
to go to general practice services17
.
A better resourced general practice would not only benefit
patients, but would also help put the NHS on a more
sustainable financial footing, with evidence suggesting that
investing in general practice could save the NHS nearly
£2 billion per year by 2020 through reducing pressure on
hospitals and other services (see Box 2 page 10). The
average cost of a face to face GP consultation is around
£45, compared to a range of £61 to £82 for a comparable
secondary care attendance18
.
GP funding as a percentage of total NHS Scotland budget
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
9.47% 9.78%
9.27%
8.31%
7.91% 7.84% 7.93% 7.78% 7.76%
GPfundingasashareofNHSexpenditure
10. A blueprint for ScottiSh generAl prActice
10
Shift NHS funding into general practice. RCGP
Scotland is calling for 11% of the total NHS budget to
be spent on general practice. Polling conducted by
ComRes in October 2014 found 71% support for this
shift among Scottish adults. The funding figure stood at
7.8% in 2012/13, compared with 9.8% in 2005/06.
Setting a clear target for increasing the proportion
of the NHS budget spent on general practice
to 11%, and putting in place a new primary care
investment plan to deliver this. Local decision makers
should be encouraged and empowered to work towards
this goal, with flexibility around how they achieve it.
●
●
●
●
RCGP Scotland calls on the Scottish Government to:
Publishing regular statistics monitoring how much
NHS funding is being directed towards primary
care, including specific figures on what proportion is
being invested in general practice.
Setting up a new five year transformation fund.
To realise the potential that general practice has to
transform patient care and help shift resources into
the community, additional resources will be needed
to transition work from secondary to primary care and
deliver change. This can be assessed by academic
evidence generated through the Scottish School of
Primary Care.
Box 2: Spend to save: the financial case for investing in general practice
Increased government spending on general practice
could lead to a saving of up to £1.9 billion to the NHS
across the uK as a whole by 2020.
Calculations by the RCGP show that increasing
spending on general practice consultations across the
uK by £72 million each year, could lead to a saving of
up to £375 million each financial year, rising to annual
savings of up to £708 million by the end of 2019/20.
The RCGP figures are based on research commissioned
from Deloitte in 201419
, which estimates that short-term
savings generated through increased spending on general
practice could amount to up to £447 million annually.
This annual saving is broken down into savings of up to:
Analysing three key patient groups — healthy patients,
frail and elderly patients, and those with long-term
conditions — Deloitte estimates that the current cost
of A&E visits is £1.58 billion. This bill could be reduced
to £1.44 billion generating annual savings of at least
£133.9 million in the uK.
Additional savings to the NHS could be made in the
medium and long-term, with additional savings of up
to £333 million annually over the course of the next
five years.
£133.9 million per year, through diverting up to 1.7
million patients away from Accident and Emergency
(A&E) departments,
●
£143.3 million per year, through reducing the
number of unnecessary ambulance call-outs, and
£170.1 million per year, through reducing the length
of hospital stays for patients aged over 65, by
providing greater primary care support at home.
greater primary care support at home.
●
●
11. JuLY 2015
11
References
1 ISD Scotland, Practice Team Information (PTI) Annual
Update, (2013). Available at: http://www.isdscotland.org/
Health-Topics/General-Practice/Publications/2013-10-
29/2013-10-29-PTI-Report.pdf
2 Gillies, Mercer, Lyon et al., Distilling the Essence of General
Practice, (2009). Available at http://www.ncbi.nlm.nih.gov/
pmc/articles/PMC2673184/
3 Healthcare Improvement Scotland and Royal College
of General Practitioners (Scotland), Developing a Quality
Framework for General Practice in Scotland, (2014).
Available at http://www.rcgp.org.uk/rcgp-near-you/rcgp-
scotland/~/media/Files/RCGP-Faculties/Scotland/RCGP-
Scotland/RCGP-Scotland-QFGP%20interactive.ashx
4 Royal College of General Practitioners (Scotland), Time To
Care: Health Inequalities, Deprivation and General Practice
in Scotland, (2010). Available at http://www.rcgp.org.uk/
rcgp-near-you/~/media/Files/RCGP-near-you-Do-Not-Use/
RCGP%20Scotland/Time%20to%20Care%20RCGP%20
Scotland%20report%20on%20Health%20Inequalities.ashx
5 Royal College of General Practitioners (Scotland), The
Future of General Practice in Scotland: A Vision, (2011).
Available at http://www.rcgp.org.uk/rcgp-near-you/~/media/
Files/Policy/A-Z-policy/RCGP-Scotland-The-Future-of-
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6 British Medical Association, GP Survey Omnibus report,
(2015). Available at: http://bma.org.uk/news-views-analysis/
news/2014/march/gp-morale-damaged-by-workload-says-
survey
7 Royal College of Nursing, Safe staffing levels – a national
Imperative: The UK nursing labour market review 2013,
(2013). Available at: http://www.rcn.org.uk/__data/assets/
pdf_file/0018/541224/004504.pdf
8 Royal College of General Practitioners and Royal
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on GP Practice Based Pharmacists, (2015). Available at:
http://www.rpharms.com/promoting-pharmacy-pdfs/rcgp-joint-
statement-for-pharmacists-in-gp-surgeries-version-2.pdf
9 Royal College of General Practitioners and Royal
Pharmaceutical Society, Breaking down the barriers –
how community pharmacists and GPs can work together
to improve patient care, (2015). Available at: http://www.
rpharms.com/public-affairs-pdfs/RPSRCGPjointstatement.pdf
10 Scottish Government, Prescription for Excellence: A
Vision and Action Plan, (2013). Available at: http://www.
gov.scot/resource/0043/00434053.pdf
11 Healthcare Improvement Scotland and Royal College
of General Practitioners (Scotland), Developing a Quality
Framework for General Practice in Scotland, (2014).
Available at http://www.rcgp.org.uk/rcgp-near-you/rcgp-
scotland/~/media/Files/RCGP-Faculties/Scotland/RCGP-
Scotland/RCGP-Scotland-QFGP%20interactive.ashx
12 British Medical Association, General Practitioner
Committee, British Medical Association GP Committee
Premises Survey - UK Results, (2014). Available at: http://
bma.org.uk/working-for-change/your-gp-cares/premises-
survey-results
13 HM Treasury and The Rt Hon George Osborne
MP, Oral statement to Parliament Chancellor George
Osborne’s Autumn Statement 2014 speech, (2014).
Available at: https://www.gov.uk/government/speeches/
chancellor-george-osbornes-autumn-statement-2014-
speech
14 HM Treasury, Autumn Statement 2014, (2014).
Available at: https://www.gov.uk/government/uploads/
system/uploads/attachment_data/file/382327/44695_
Accessible.pdf
15 Ibid.
16 Royal College of General Practitioners, ‘300,000
signatures strong’, campaign blog, (20 October 2014).
Available at: http://www.rcgp.org.uk/campaign-home/
news-and-blogs/2014/october/campaign-blog-300000-
signatures-strong.aspx
17 Royal College of General Practitioners, ‘Majority of
public believe GP workloads are threat to the level of
patient care’, press release (2014). Available at: http://
www.rcgp.org.uk/news/2014/march/majority-of-public-
believe-gp-workloads-threat-to-level-of-patient-care.aspx
18 Deloitte, Spend to save: The economic case for
improving access to general practice, a report for the
RCGP, (2014). Available at: http://www.rcgp.org.uk/
campaign-home/~/media/Files/PPF/2014-RCGP-Spend-
to-Save-Deloitte-report.ashx
19 Ibid.