The document discusses a meeting to provide development and support for general practice managers, covering topics such as managing workload in general practices, sharing challenges and solutions, professional development opportunities, and leading primary care into the future. Attendees include representatives from various NHS organizations focused on supporting general practice. The document emphasizes the importance of practice managers sharing their knowledge and experiences to help their colleagues and promote excellence in primary care.
The document discusses managing workload in general practice. It identifies some of the biggest challenges as the increasing pressure on practices from a growing and aging population, rising costs, and increasing bureaucracy. It discusses the GP Forward View's focus on improving access to care, long-term conditions management, and collaborative working. The document then summarizes some approaches practices are taking to better manage workload, such as introducing new ways of working to reduce wasted time, matching capacity to demand, improving processes, creating a more productive environment, supporting self-care, prevention initiatives, online services to streamline tasks, and more proactive long-term condition management.
Break-out session slides Session 2: 2.3 Care navigation - Janis TateNHS England
Care navigation is a person-centered approach that helps primary care patients move through the health and social care system smoothly. It involves reception staff and care navigators signposting patients to the most appropriate care option. Implementing care navigation in Herefordshire resulted in benefits for patients, staff, and GPs. Patients had more choice and access to services, staff experienced increased job satisfaction, and GPs saved approximately 1314 hours over 9 months through reduced inappropriate appointments.
Designing the future primary care workforce (SouthWest workshop 23/04/18)Robert Varnam Coaching
The document discusses avoiding common pitfalls in designing the future of general practice. It recommends: 1) designing for future needs rather than current constraints, 2) considering the whole healthcare system and existing capabilities, 3) using patient segmentation cautiously to understand needs rather than dictate new roles, 4) ensuring plans cover the broader system and its changes, 5) planning for developing new skills in addition to recruitment, 6) committing staff through a compelling vision, and 7) thoroughly planning implementation with a focus on participation.
Quality, Innovation, Productivity and Prevention in Primary CareNHSScotlandEvent
What do the Quality Ambitions mean for Primary Care? This session describes the ongoing innovative local improvements and national work with NHS
Boards and Primary Care contractors to improve quality, efficiency and outcomes as well as the future plans for Primary Care.
1. The document discusses the future of general practice and primary care in the UK. It argues that primary care needs to operate at a larger scale to effectively partner with other parts of the health system, deliver expanded services, and ensure sustainability.
2. However, larger scale operations also need to maintain the personal aspects of care that are important to patients and staff. This will require deliberate design of organizational structures, culture, and care models.
3. The optimal design will create organizations that are bigger in scale but also personal, capable of transformation and partnership, and still feel like "yours" to staff.
Embedding the vision of Future in Mind and the Five Year Forward View for Men...CYP MH
This document discusses strategies for personalizing psychosocial mental health interventions based on an article by Ng and Weisz. It provides examples of 8 strategies: 1) Adapting empirically supported therapies for specific subgroups, 2) Using therapies that alter environments like family or school, 3) Using modular therapies that can be combined as needed, 4) Using sequential multiple assignment randomized trials to sequence treatments, 5) Using assessments to provide treatment feedback, 6) Comparing alternative strategies within trials, 7) Using data mining to develop decision tools, and 8) Calculating expected treatment benefits accounting for patient characteristics. Each strategy is briefly defined and an example study is described.
The document discusses managing workload in general practice. It identifies some of the biggest challenges as the increasing pressure on practices from a growing and aging population, rising costs, and increasing bureaucracy. It discusses the GP Forward View's focus on improving access to care, long-term conditions management, and collaborative working. The document then summarizes some approaches practices are taking to better manage workload, such as introducing new ways of working to reduce wasted time, matching capacity to demand, improving processes, creating a more productive environment, supporting self-care, prevention initiatives, online services to streamline tasks, and more proactive long-term condition management.
Break-out session slides Session 2: 2.3 Care navigation - Janis TateNHS England
Care navigation is a person-centered approach that helps primary care patients move through the health and social care system smoothly. It involves reception staff and care navigators signposting patients to the most appropriate care option. Implementing care navigation in Herefordshire resulted in benefits for patients, staff, and GPs. Patients had more choice and access to services, staff experienced increased job satisfaction, and GPs saved approximately 1314 hours over 9 months through reduced inappropriate appointments.
Designing the future primary care workforce (SouthWest workshop 23/04/18)Robert Varnam Coaching
The document discusses avoiding common pitfalls in designing the future of general practice. It recommends: 1) designing for future needs rather than current constraints, 2) considering the whole healthcare system and existing capabilities, 3) using patient segmentation cautiously to understand needs rather than dictate new roles, 4) ensuring plans cover the broader system and its changes, 5) planning for developing new skills in addition to recruitment, 6) committing staff through a compelling vision, and 7) thoroughly planning implementation with a focus on participation.
Quality, Innovation, Productivity and Prevention in Primary CareNHSScotlandEvent
What do the Quality Ambitions mean for Primary Care? This session describes the ongoing innovative local improvements and national work with NHS
Boards and Primary Care contractors to improve quality, efficiency and outcomes as well as the future plans for Primary Care.
1. The document discusses the future of general practice and primary care in the UK. It argues that primary care needs to operate at a larger scale to effectively partner with other parts of the health system, deliver expanded services, and ensure sustainability.
2. However, larger scale operations also need to maintain the personal aspects of care that are important to patients and staff. This will require deliberate design of organizational structures, culture, and care models.
3. The optimal design will create organizations that are bigger in scale but also personal, capable of transformation and partnership, and still feel like "yours" to staff.
Embedding the vision of Future in Mind and the Five Year Forward View for Men...CYP MH
This document discusses strategies for personalizing psychosocial mental health interventions based on an article by Ng and Weisz. It provides examples of 8 strategies: 1) Adapting empirically supported therapies for specific subgroups, 2) Using therapies that alter environments like family or school, 3) Using modular therapies that can be combined as needed, 4) Using sequential multiple assignment randomized trials to sequence treatments, 5) Using assessments to provide treatment feedback, 6) Comparing alternative strategies within trials, 7) Using data mining to develop decision tools, and 8) Calculating expected treatment benefits accounting for patient characteristics. Each strategy is briefly defined and an example study is described.
An integrated care pathway – CAMHS and counselling working together-Liverpool...CYP MH
The document outlines the development of Liverpool's integrated CAMHS partnership over time. It summarizes:
1) The partnership has expanded from a single provider model to include voluntary sector organizations, with the goal of providing a continuum of mental health care.
2) Key milestones included establishing a single point of access, multi-agency triage, and more community-based services.
3) Current priorities include further implementing evidence-based practices, improving participation, and transforming services through the CYP IAPT program to improve outcomes for children and families.
How is quality faring? Priorities and impact on the frontlineQualityWatch
A presentation given to the QualityWatch 2015 annual conference by Professor Tim Evans, Medical Director and Responsible Officer, Royal Brompton and Harefield NHS Foundation Trust.
Developing a Successful Crisis Response Team for Young People - WorkshopCYP MH
CYPMH conference 2016 Future in Mind Vision to Implementation
Developing a Successful Crisis Response Team for Young People -
Clare Anderson and team (Tees, Esk and Wear Valleys NHS Foundation Trust)
Introduction to Human Factors
Mark Johnston NHS Education for Scotland
Patient Safety
More at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety.aspx
Changing practice through knowledge translation and implementation science.
Have you asked, told, taught and begged, but your hand hygiene results aren’t changing as quickly as you want? Changing practice is hard! Join CPSI on May 4th for an interactive webinar exploring the fundamentals of knowledge translation and the efforts of Public Health Ontario to change practice through this innovative science. We will also look at how you can impact patient and family hand hygiene efforts through the successful use of campaigns.
Canadian healthcare organizations are taking patient and family engagement to new heights and the best of the best want to share the secrets of their success with you!
Improving acute care for children and young people, pop up uni, 10am, 3 septe...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
Improving access to seven day services - Taunton 4th March 2015
The first of the regional events for the south took place in Taunton on 4 March. Over 100 delegates from local health and social care organisations came together with patient, public and voluntary sector representatives to hear about the expectations, opportunities and challenges of delivering seven day services and to review and further develop plans for their local communities.
Interactions between the delegates in their local health and social care communities, supported by the NHS Improving Quality team, made this a vibrant event with everyone contributing to the table discussions during the day.
Key themes emerging during the day included:
• The need for system resilience group members to fully understand the skills and “offer” that each of them can bring to the table to improve health and social care seven days a week. This was highlighted in discussions around clinical standard 9, which many groups focussed on as their top priority.
• The need to have an effective system of information sharing between all parts of the health and social care system.
• The huge role that patients and public groups have to play in planning services.
iWantGreatCare's 7th National Symposium - Building fantastic staff morale, improving quality and reducing costs - took place on Tuesday 21st June at The King's Fund, London.
NHS leaders share their experiences of how they are building excellence in their Trust, reducing costs and growing staff morale by listening to the voice of the patient.
View the slides from these well-regarded delegates:
Alwen Williams, Chief Exective, Barts Health NHS Trust
David Behan, Chief Executive, Care Quality Commission
Dr Nadeem Moghal, Medical Director, Barking, Havering and Redbridge University Hospitals NHS Trust
Liz Mouland, Chief Nurse, First Community Health and Care
Jeremy Howick, clinical epidemiologist and philosopher
NICE Master Class final presentation 25 11 14 (including workshops)NEQOS
Collaborating for Better Care Partnership Master Class with NICE: 'Putting Evidence into Practice' - complete ppt slide pack including the workshop ppts and web links.
Master Class 'Putting evidence into practice' (plenary) presentation 25 11 14NEQOS
This document summarizes a master class on implementing evidence into practice using NICE guidance and quality standards. The event included presentations on NICE guidance and quality standards, a case study on implementing dementia guidance, and workshops on NICE pathways and resources. The goal was to improve awareness of NICE implementation support and consider challenges to applying evidence locally.
Projects at the Heart of Creating the Right Culture David McNallyAllie Bailey
The document discusses patient experience in the NHS and how it relates to clinical effectiveness and safety. It provides definitions of patient experience, quality care, and leadership culture. It examines how patient feedback is collected and used, and its relationship to staff experience, engagement, and advocacy. Tools like the Culture of Care Barometer and Schwartz Rounds that assess workplace culture and support staff are also summarized.
The changing vanguard workforce, pop up uni, 11am, 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
This document summarizes an article aimed at helping healthcare provider boards improve their understanding and oversight of patient experience. It provides guidance on measuring patient experience, including highlighting areas that are important to patients but have seen little progress. The summary emphasizes that focusing on patient experience is critical for an organization's reputation and quality of care, as well as a board's statutory duty. It signposts board members to sections of the report that provide practical recommendations on discussing patient experience intelligence and insights from other healthcare leaders.
This document provides top ten tips for improving access to general practice at scale. The tips include securing needed capacity by protecting leadership time and early succession planning, choosing the right approach such as coproducing plans, considering capabilities like business intelligence and service redesign, ensuring access to patient records, engaging patients, planning for costs and accounting, and using measurement to motivate and ensure accountability. The overall message is providing guidance on improving large-scale access to general practice services.
An integrated care pathway – CAMHS and counselling working together-Liverpool...CYP MH
The document outlines the development of Liverpool's integrated CAMHS partnership over time. It summarizes:
1) The partnership has expanded from a single provider model to include voluntary sector organizations, with the goal of providing a continuum of mental health care.
2) Key milestones included establishing a single point of access, multi-agency triage, and more community-based services.
3) Current priorities include further implementing evidence-based practices, improving participation, and transforming services through the CYP IAPT program to improve outcomes for children and families.
How is quality faring? Priorities and impact on the frontlineQualityWatch
A presentation given to the QualityWatch 2015 annual conference by Professor Tim Evans, Medical Director and Responsible Officer, Royal Brompton and Harefield NHS Foundation Trust.
Developing a Successful Crisis Response Team for Young People - WorkshopCYP MH
CYPMH conference 2016 Future in Mind Vision to Implementation
Developing a Successful Crisis Response Team for Young People -
Clare Anderson and team (Tees, Esk and Wear Valleys NHS Foundation Trust)
Introduction to Human Factors
Mark Johnston NHS Education for Scotland
Patient Safety
More at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety.aspx
Changing practice through knowledge translation and implementation science.
Have you asked, told, taught and begged, but your hand hygiene results aren’t changing as quickly as you want? Changing practice is hard! Join CPSI on May 4th for an interactive webinar exploring the fundamentals of knowledge translation and the efforts of Public Health Ontario to change practice through this innovative science. We will also look at how you can impact patient and family hand hygiene efforts through the successful use of campaigns.
Canadian healthcare organizations are taking patient and family engagement to new heights and the best of the best want to share the secrets of their success with you!
Improving acute care for children and young people, pop up uni, 10am, 3 septe...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
Improving access to seven day services - Taunton 4th March 2015
The first of the regional events for the south took place in Taunton on 4 March. Over 100 delegates from local health and social care organisations came together with patient, public and voluntary sector representatives to hear about the expectations, opportunities and challenges of delivering seven day services and to review and further develop plans for their local communities.
Interactions between the delegates in their local health and social care communities, supported by the NHS Improving Quality team, made this a vibrant event with everyone contributing to the table discussions during the day.
Key themes emerging during the day included:
• The need for system resilience group members to fully understand the skills and “offer” that each of them can bring to the table to improve health and social care seven days a week. This was highlighted in discussions around clinical standard 9, which many groups focussed on as their top priority.
• The need to have an effective system of information sharing between all parts of the health and social care system.
• The huge role that patients and public groups have to play in planning services.
iWantGreatCare's 7th National Symposium - Building fantastic staff morale, improving quality and reducing costs - took place on Tuesday 21st June at The King's Fund, London.
NHS leaders share their experiences of how they are building excellence in their Trust, reducing costs and growing staff morale by listening to the voice of the patient.
View the slides from these well-regarded delegates:
Alwen Williams, Chief Exective, Barts Health NHS Trust
David Behan, Chief Executive, Care Quality Commission
Dr Nadeem Moghal, Medical Director, Barking, Havering and Redbridge University Hospitals NHS Trust
Liz Mouland, Chief Nurse, First Community Health and Care
Jeremy Howick, clinical epidemiologist and philosopher
NICE Master Class final presentation 25 11 14 (including workshops)NEQOS
Collaborating for Better Care Partnership Master Class with NICE: 'Putting Evidence into Practice' - complete ppt slide pack including the workshop ppts and web links.
Master Class 'Putting evidence into practice' (plenary) presentation 25 11 14NEQOS
This document summarizes a master class on implementing evidence into practice using NICE guidance and quality standards. The event included presentations on NICE guidance and quality standards, a case study on implementing dementia guidance, and workshops on NICE pathways and resources. The goal was to improve awareness of NICE implementation support and consider challenges to applying evidence locally.
Projects at the Heart of Creating the Right Culture David McNallyAllie Bailey
The document discusses patient experience in the NHS and how it relates to clinical effectiveness and safety. It provides definitions of patient experience, quality care, and leadership culture. It examines how patient feedback is collected and used, and its relationship to staff experience, engagement, and advocacy. Tools like the Culture of Care Barometer and Schwartz Rounds that assess workplace culture and support staff are also summarized.
The changing vanguard workforce, pop up uni, 11am, 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
This document summarizes an article aimed at helping healthcare provider boards improve their understanding and oversight of patient experience. It provides guidance on measuring patient experience, including highlighting areas that are important to patients but have seen little progress. The summary emphasizes that focusing on patient experience is critical for an organization's reputation and quality of care, as well as a board's statutory duty. It signposts board members to sections of the report that provide practical recommendations on discussing patient experience intelligence and insights from other healthcare leaders.
This document provides top ten tips for improving access to general practice at scale. The tips include securing needed capacity by protecting leadership time and early succession planning, choosing the right approach such as coproducing plans, considering capabilities like business intelligence and service redesign, ensuring access to patient records, engaging patients, planning for costs and accounting, and using measurement to motivate and ensure accountability. The overall message is providing guidance on improving large-scale access to general practice services.
Presentation at the RCGP East Anglia faculty annual symposium. Reflections on the current pressures facing general practice, the vision presented in the NHS Five Year Forward View and some of the ways in which practices can lead for the future
NHS finances: the challenge all policital parties need to face - charts and t...The Health Foundation
The document discusses NHS finances and the challenge of funding the NHS that all political parties must address. It provides historical data on UK public spending on health from 1949 to 2014, which shows spending increasing from 3.6% to 7.5% of GDP. The document also examines projections for NHS funding pressures, estimating a funding gap of £108 billion by 2030 if productivity does not increase. Maintaining productivity growth could reduce the gap but would require unprecedented long-term improvement. All parties will need to decide how best to fund growing demands on the healthcare system.
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.
Workshop on the 10 High Impact Actions to release time for care. View of the strengths of primary care, ways to release more of their potential and the contribution of the General Practice Forward View. At county-wide primary care, Worcestershire.
NHS finances: the challenge all political parties need to face - updated tabl...The Health Foundation
View the full set of charts and tables from our 2015 briefing 'NHS finances: the challenge all political parties need to face' - some of the data was updated in May 2015 and this slidepack reflects those updates.
The document discusses the changing needs of primary care and general practice in the UK. It notes increasing pressures on general practice from a growing and aging population with more complex needs. Specifically, it highlights the rise in patients with multiple long-term conditions which now accounts for over half of primary care work. This qualitative change in patient needs requires a shift away from an acute, episodic model of care towards holistic, population-based management of long-term conditions. The document advocates for greater collaboration between primary care providers and specialists, as well as expanded skillmix and services delivered closer to home in order to better meet patients' needs.
This document summarizes the partnership between the National Institute for Health Research (NIHR) and industry to support clinical research and innovation in the UK. Key points:
- NIHR invests over £1 billion annually in research infrastructure including clinical trials facilities to support industry partnerships and clinical research.
- In 2015/16 this infrastructure supported over 11,000 studies, recruited over 320,000 patients, and resulted in over 1,300 collaborations and 576 partnerships with industry worth £149.7 million.
- Examples are provided of NIHR funding programs that support translational research and adoption of novel technologies, helping to bridge the "valley of death" between research and commercialization.
This document discusses approaches for achieving transformational change through collaboration. It describes how the Sustainable Improvement Team at NHS England has supported over half of UK clinical commissioning groups and general practices to implement changes. The document emphasizes investing in leadership skills for large-scale change using evidence-based tools and theories of change. It provides an example of how a UK medical practice achieved transformational change by extending their practice team, managing demand through care navigation and social prescribing, and supporting self-help efforts.
The document summarizes the recommendations of the National Data Guardian's reviews of data security, consent, and opt-out in the UK. It discusses the National Data Guardian establishing 10 data security standards across three themes - people, processes, and technology. It also proposes a new consent/opt-out model for patients regarding how their personal confidential information can be used beyond direct care, including for local services/running the NHS, research, and treatment improvement. The Department of Health is now consulting on and testing the recommendations before full implementation.
The document outlines an agenda for a meeting that will cover: what a course on leading together has done and why; how the course is run; what past participants have said about the course; and what's next. It then provides details on several topics: the structure and model of involvement for the course; experiential learning approaches used; and feedback from past participants, who described the course as exciting, motivating, insightful and rewarding. The goal of the course is to achieve equal dialogue and build innovative, co-produced solutions through experiential learning and a focus on personal, relational and system leadership.
This document discusses strategies for managing workload in general practice through 10 high impact actions:
1. Introducing new ways of working to reduce wasted time and ensure issues are addressed at first contact.
2. Matching capacity to demand by adjusting staffing schedules.
3. Applying lean principles to improve common processes and reduce errors and waste.
4. Optimizing the physical layout and information systems to boost productivity.
5. Supporting self-care through signposting, education, and online access to records and test results.
6. Developing community prevention programs to improve population health.
The General Practice Forward View - what does it mean for my practice?Robert Varnam Coaching
The document discusses pressures on general practice from increasing population, consultations, complexity and costs while funding and workforce are decreasing relatively. It notes the rise of multimorbidity with age which accounts for over half of primary care work and represents a qualitative change from episodic illness to ongoing management of multiple chronic conditions. The General Practice Forward View aims to address these challenges through actions like expanding the workforce, reducing bureaucracy, implementing online booking and reminders, and establishing multispecialty community providers for more comprehensive community care.
Presentation at 2016 annual conference of the Royal New Zealand College of GPs (RNZCGP), Auckland, 28 July 2016. A consideration of the pressures and opportunities facing general practice, the 10 High Impact Actions to release time for care, and the journey we may need to take to realise more of the potential of primary care.
The document discusses the future of general practice in the UK. It notes that while general practice is currently constrained and facing challenges, there are reasons for optimism going forward. New funding, workforce growth, and infrastructure improvements are helping to deliver a new deal for general practice. However, simply doing more of the same is not enough - qualitative changes are needed to better serve patients with long-term conditions. New organizational forms and care models are being implemented to help general practice realize its full potential and meet future needs.
The future of general practice - how can the PM Challenge Fund help?Robert Varnam Coaching
A presentation to GPs in Worcester, reflecting on the challenges facing general practice, presenting the emerging evidence about successful GP federations and suggesting ways in which GP practices can take their destiny in their hands and release more of their potential.
Presentation to practices in Lincolnshire, looking at the strengths of primary care, the ways in which it could deliver more of the promise and emerging lessons about successful at-scale primary care.
Session for GP practices in the STAR scheme in South Tees, part of the PM Challenge Fund. Exploring the reasons why everyone is talking about change in general practice, some of the emerging evidence from the Challenge Fund, and thoughts about how to move forward together.
The document discusses transforming primary care by freeing up GP time. It outlines 10 high impact actions that can be taken to release time for direct patient care, including providing online patient portals, phone and email consultations, appointment reminders, expanding the care team with nurses and pharmacists, and improving processes and matching capacity to demand. The goal is to shift from a model of episodic acute care to one better able to meet the needs of an aging population with multiple long-term conditions through more holistic and coordinated care.
A brief overview of the support aavailable in the General Practice Forward to help practices implement changes that will release time for care. Presenation to Lincolnshire LMC 25/05/17
The future of primary care and implementing workforce innovations (Wessex AHSN)Robert Varnam Coaching
Presentation at Wessex AHSN event "Lifeline for general practice" event in Southampton. Including updates about the national general practice development programme, and tips on making a success of new ways of working.
This document discusses the future of primary care in the UK. It notes increasing pressures on general practice from a rising and aging population with more complex needs. Specifically, it highlights the growing problem of multimorbidity where older patients have multiple long-term conditions. It argues this represents a fundamental shift in the nature of primary care work toward managing non-curable chronic conditions rather than acute episodic illnesses. The document advocates for changes in how primary care is organized and delivered to better meet patients' changing needs.
1) General practice is under pressure due to increasing patient populations, consultations, complexity of cases, and costs while receiving decreasing relative funding and workforce.
2) The needs of patients are changing as more have multiple long-term conditions requiring holistic and ongoing care rather than occasional acute issues.
3) To meet changing patient needs, general practice will need to move away from the traditional model of GPs as gatekeepers and work more collaboratively within integrated systems using a broader workforce.
Presentation to Dudley CCG members' meeting, 26 Mar 2019. Looking at the lessons from some of the successes and disappointments of integrated care, and some of the top tips for redesigning general practice to release more of its potential.
Presentation to practice managers about the need to release time for care, national plans in the General Practice Forward View and local actions that can free up time and improve care.
This document discusses ways to reduce pressures on general practice and free up clinicians' time for patient care. It outlines 10 high impact actions for practices to implement, including providing online patient portals, using phone and email consultations where appropriate, maximizing appointment slots by reducing missed appointments through reminders and easier cancellation policies, and introducing reception care navigation and group consultations for long-term conditions. The overall goal is to shift the model of care away from a focus on acute problems and toward better management of patients with multiple long-term conditions.
Similar to Practice Manager networking event, 15 Dec (20)
This document discusses the importance of leading with why. It notes that most change efforts fail despite having a good idea, clear instructions, and performance controls. Leading with why means connecting changes to what motivates and inspires staff. The document emphasizes telling a story that explains the reasons and purpose behind changes, rather than just giving instructions. This helps gain support from more people for the leader's vision.
The document discusses common pitfalls in trying to enact change in healthcare. It advises to start with the end goal in mind and plan thoroughly through testing and refining in order to succeed. It also warns against being too eager to contribute without focusing on the desired outcome and what patients need rather than what one can contribute.
The document discusses considerations for primary care clinical commissioning groups (PCNs) that have recently formed. It identifies common issues that PCNs spend time on such as governance structures, payment distributions, and contracts. The document also discusses lessons learned from common pitfalls when forming PCNs like not prioritizing clinician time or leadership development. Finally, it emphasizes the importance of PCNs establishing a clear purpose before focusing on specific functions or organizational structures.
Time for Care. South & North Tandridge Network Group Training EventRobert Varnam Coaching
This document discusses opportunities for primary care networks and general practices to better collaborate and manage workload. It notes that primary care provides continuity, is community-focused, holistic, and comprehensive, but that current demand exceeds workforce capacity. Opportunities for collaboration through primary care networks include staff pooling, shared functions, specialist services, planning, analytics, recruitment and career development. However, meaningful collaboration requires deliberate effort to build relationships through open communication and joint practical improvements. The document also analyzes sources of workload for general practices and promotes innovations from other practices that can help manage demand and release clinician time.
Primary care networks, realising the potential and avoiding the pitfallsRobert Varnam Coaching
Presentation at the Management in Practice conference, 4 December 2018. What are we learning about the potential benefits of primary care networks for patients and practices, and the practicalities of realising the potential?
Keynote talk at Best Practice 2018. Observations about the critical success factors for leaders wishing to unpack the potential of primary care networks to benefits patients and GP practices.
Presentation at Pulse Live, Liverpool 2 Oct 2018. What are the potential benefits of primary care networks for patients and staff? What can we learn about how to approach the process of establishing a productive primary care network?
Workshop at Health and Care Innovation Expo 2018, in Manchester. It can take up to 20 years for good innovations to be adopted in healthcare. However, the recently published 10 High Impact Actions for general practice are spreading faster than we have ever seen. Why? Learn about what's different, and how you can increase success in your own work.
The presentation examines the role of five stages in the innovation journey in determining success: the innovators, the innovation, packaging, spread and adoption. Examples are provided of how each can present a barrier, and how the national Time for Care programme has sought to overcome them.
The document discusses leadership in general practice and healthcare. It emphasizes that leadership matters, great care does not just happen, and leaders are made, not born. It encourages investing in your own growth as a leader, not waiting to be the boss, and trying fearlessly while learning from failures.
The document discusses online consultation systems for general practices. It provides information on the benefits of online consultations for patients and practices. Key points include:
- Online consultations can provide improved and more convenient access to healthcare, help manage practice workload more efficiently, and allow for more effective face-to-face appointments.
- £45 million in funding over three years is available for practices to purchase and use online consultation systems.
- Examples of scenarios where online consultations could help address patient issues are presented.
This document discusses strategies to help general practitioners manage their workload and free up time. It provides information on 10 high impact actions that practices have taken, such as improving online services for patients, using nurses to handle minor illnesses, reducing missed appointments, and broadening the care team. Data is presented on sources of workload such as administrative tasks and potentially avoidable appointments. The importance of staff training and well-being is also emphasized.
The document discusses the General Practice Forward View and the opportunities and pressures facing general practice in the UK. It notes that general practice provides comprehensive, holistic care from cradle to grave but is under pressure. There is an opportunity to reimagine care through multidisciplinary teams, working at scale across larger populations, and freeing up GP time through innovations. This could help general practices better deliver on the promise of primary care and help address pressures on the whole NHS.
This document discusses the General Practice Forward View, which aims to help general practice deliver more of its potential through improved access, comprehensive care, population health management, empowering self-care, and ensuring the right care is delivered by the appropriate provider. It highlights priorities like workforce development, service redesign, self-care, and technology. The document specifically addresses how technology like online consultations could help with access, self-care, proactive care, population management, and collaborative work. It announces a new £45 million online consultations fund over three years to help practices implement online consultation software.
Practice development support in the General Practice Forward View (Pulse Live)Robert Varnam Coaching
Presentation at Pulse Live London on the range of support available from the General Practice Forward View, and tips on ways to identify your particular priorities
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This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
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Mental Health and well-being Presentation. Exploring innovative approaches and strategies for enhancing mental well-being. Discover cutting-edge research, effective strategies, and practical methods for fostering mental well-being.
2. #GPforwardview
Welcome
Welcome and housekeeping
Context setting
Your priorities and questions
Running the practice
The importance of sharing
Managing workload in the practice
Share challenges & solutions
Professional development
Leading primary care into the future - lessons so far
Opportunities for sharing and development
Your personal development
Next steps
4. #GPforwardview
Who’s here?
General Practice Development Team
• Sue Pritchard
• Sandra McGregor
• Patricia Dolor
• Robert Varnam
Sustainable Improvement Team
• Christine McDermott
• Sheinaz Stansfield
Patient Online Team
• James Blanchard
Practice Management Network
• Steve Williams
Practice Index
• James Dillon
7. #GPforwardview
So why are people talking about change?
It’s partly about the pressure we’re under
right now, and partly about the huge
opportunity to do something better. And,
for once, the same changes that would
help with one are also necessary for the
other.
Pressure Opportunity
9. #GPforwardview
At the heart of the case for change is not the workload of practices – important though that is – it is the needs of patients, and
they way they are changing. When the NHS was founded, its purpose was fairly simple. Every now and then, people got ill.
When they did, they consulted their doctor. If it was a straightforward problem, they would give a prescription, the person
would get better, return to work and, in a year or two, they might need the doctor again. If it was less straightforward, they
would be referred to a clever doctor – who would give a prescription or cut out the offending part. The patient would then get
better, return to work, and, in a year or two, they might become ill again.
That accounted for the majority of the anticipated work of the NHS. And, for some patients, that’s still the kind of care that’s
needed.
However, a growing proportion of our work is fundamentally different. This now seminal chart illustrates the central fact
underlying the quantitative and qualitative change in the work of primary care. It illustrates the rise in multimorbidity with age.
As people get older, they have more simultaneous longterm conditions. So that, by the age of 75, for example, at least a third
of people are living with four or more LTCs. And, as our demography changes, the proportion of older people increases.
Dealing with longterm conditions already accounts for over half of work in primary care. It is set to increase.
And, crucially, this represents a qualitative change in the nature of work. These are not people who visit the GP every year or
two to get cured of their problem. These are people with problems that we cannot cure – they are living with multiple issues
which will not go away, and they visit the GP six, seven, eight or more times a year. At least. Furthermore, the more
simultaneous problems someone has, or the greater their frailty, the less helpful it is to pass their care to a doctor specialising
in one part of the body. These people need treating as people, not diseases.
So the population of people who need what only primary care can offer has grown, the amount of time they need has grown –
and both are set to continue growing. This is the chief case for change in primary care, the pressure of patients’ needs.
This is not a blip requiring a short-term correction to the priorities of the NHS. It is a fundamental shift which requires every
developed nation on earth to turn away from what Muir Gray has termed the ‘century of the hospital’, and place the emphasis
where the population’s need is.
Based on: The Lancet doi: 10.1016/S0140-6736(12)60240-2
20. #GPforwardview
So why are people talking about change?
It’s partly about the pressure we’re under
right now, and partly about the huge
opportunity to do something better. And,
for once, the same changes that would
help with one are also necessary for the
other.
Pressure Opportunity
21. #GPforwardview
What are the biggest challenges in
running the practice productively?
What would you most like to learn from
colleagues today?
Your priorities
22. The importance of sharing ~
The GP Forward View and Practice Manager
Development Programme
Welcome!
23. • Practice manager development
• Practice managers are a vital resource in the NHS, playing a key role
in maintaining a quality service and in redesigning care for the
future. Yet they are also one of the most neglected parts of the
workforce, receiving relatively little formal training or ongoing
development. Many practice managers report feeling overburdened
and isolated in their role, and it is often noted that the most
efficient ways of working are slow to spread between practices.
• NHS England 2016
General Practice – The increasing
workload
24. • Practice manager development
• We want to share our wide experience as business managers with
our colleagues in practice management and with others in the NHS.
We want to promote excellence, provide practical support and
identify examples of good practice. We will identify sources of
expertise and encourage collaboration.
• We will champion the cause of practice management and the
development of ever higher professional standards.
• Practice Management Network 2009
General Practice – The increasing
workload
25. • Aligned to 7 health
organisations
• 10 high impact actions
champions
• 209 CCG lead opportunities
• 7,500+ Practice Managers
• 70,000+ Practice Staff
• The Practice Management
Network (initially supported by
the Department of Health)
• Over 4,100 registered managers
• 14 steering group members
• 4 regional representatives
General Practice – The importance of
sharing
26. General Practice – The Way Forward
10 High Impact Actions Champions
Active signposting -
New consultation types -
Reduce DNA’s -
Develop the team -
Productive work flows -
Personal productivity -
Partnership working –
Use social prescribing –
Support self care and management -
Build QI expertise -
2 x Co-chairs
NORTH
SOUTH
MIDLANDS AND
EAST LONDON
209 CCG’s
BMA
NEW NHS ALLIANCE
IHM
RCGP
AMSPAR
NAPC
FAMILY DOCTORS
ASSOCIATION
27. • Performance reviews
• Other resources
• The GP forward view
• Leader or follower ?
• General Practice Today –
The Challenges
• Who’s who in your practice
• Practice policies
• Practice benefits
General Practice – The importance of
sharing
28. • Support for PM’s and a voice
• Representing the profession, professional development and
primary care transformation
• Support for PM’s in terms of brainstorming and problems
• To ensure that PM’s are fully supported in their work and are
allowed to develop their skills
General Practice – What You Say
SUPPORT
29. • Understanding the main
challenges faced in surgery.
• Supporting your team to
manage workload and
identifying where to delegate
appropriate tasks
• How does this fit into the
General Practice Forward View?
• What do the Five Year and
General Practice Forward Views
mean to my practice.
• How can I take part in the
initiatives and access funding?
• Taking a leadership role in
driving improvements in
provision of primary care.
General Practice – The Challenges
30. General Practice – The Way Forward
In a survey of almost 2,000 people in Great Britain, the most
commonly perceived barriers to seeing a GP were finding it
difficult to get an appointment with a particular doctor (42 per
cent), or at a convenient time (42 per cent), and disliking
having to talk to GP receptionists about symptoms (40
percent).
11th October 2016
31. General Practice – The Way Forward
Receptionists 'put people off seeing doctor‘
11th October 2016
Patient: "They (receptionists) sometimes think they're the
doctors"
Receptionists quizzing patients about why they need to see
their GP could be putting some sick people off visiting their
surgery, a survey suggests.
Of almost 2,000 adults questioned for Cancer Research UK,
four in 10 said they disliked having to discuss their ills with
office staff in order to get an appointment.
36. General Practice – The Way Forward
The PMn is in discussion with NHSE to determine how the
funding of £6 million can be best utilised
AMSPAR already provide education and training with the
Level 5 certificate/diploma in Primary Care Healthcare
Management and offer professional membership
The NAPC with help from the PMn will be introducing an Advanced
Practice Manager Programme – expected October 2017
37. General Practice – The Way Forward
Share your knowledge.
It’s a way to achieve
immortality.
Dalai Lama
(1357-1419, high lama of
Tibetan Buddhism)
Let’s try it once without the parachute.
Image: Cartoonresource (Shutterstock)
38. C’mon guys, we’ll find someone with the answers. Just keep
looking.
Image: Cartoonresource (Shutterstock)
Sharing is sometimes
more demanding than giving.
Mary Catherine Bateson
(*1939, American writer and cultural anthropologist)
Scientia potentia est: Knowledge is Power.
commonly attributed to Sir Francis Bacon
(1561-1626, English philosopher, statesman, and scientist)
48. #GPforwardview
10 High Impact Actions to release time for care
Innovations from around England
that release time for GPs to do
more of what only they can do.
bit.ly/gpcapacityforum
49. #GPforwardview
10 High Impact Actions to release time for care
Innovations from around England
that release time for GPs to do
more of what only they can do.
bit.ly/gpcapacityforum
bit.ly/gpcapacityforum
50. #GPforwardview
10 High Impact Actions to release time for care
Innovations from around England
that release time for GPs to do
more of what only they can do.
bit.ly/gpcapacityforum
Introduce new ways of working which enable staff to work smarter, not just harder. These can reduce wasted time, reduce queues, ensure more
problems are dealt with first time and that uncomplicated follow-ups are less reliant on GPs consultations.
Match capacity with demand
Appointment systems and staff rotas are designed in order to ensure sufficient capacity is available to match patterns of demand as they vary
through the week and the year. This requires an ongoing system of measuring demand and adjusting capacity accordingly. It may also involve
scheduling routine work (eg annual reviews and clinical audit) for less busy times of the year. The benefits are a reduction in delays for
appointments, less stress for staff and patients, and better access.
Efficient processes
The application of Lean principles to measure, understand and improve common processes in the practice, in order to reduce waste and errors.
Typical targets include clinical follow-up protocols, processing of letters and test results, requests from patients, staff messages and team
decision making. Staff themselves often have a wealth of ideas about ways in which processes could be improved to release time. Practices who
take a systematic approach to identifying and testing these generally find that this improves care for patients as well as freeing staff time for other
things. The use of pre-prepared plans for managing common simple follow-up processes can improve their reliability and efficiency, freeing GP
time. Common examples include management of hypertension, monitoring of tests after the initiation of new medication, and adjustment of
medication doses to reach a target.
Productive environment
The physical layout within the practice is assessed for its effect on staff's productivity, and improvements are introduced which reduce wasted
time. The Lean technique of 5S is the best known approach for doing this. Additionally, work can be undertaken to ensure that staff can access
information needed to support their work quickly. This reduces time spent searching for information and can improve patient safety as well.
52. #GPforwardview
10 High Impact Actions to release time for care
Innovations from around England
that release time for GPs to do
more of what only they can do.
bit.ly/gpcapacityforum
Take every opportunity to support people to play a greater role in their own health and care. This begins before the consultation, with methods of
signposting patients to sources of information, advice and support in the community. Common examples include patient information websites,
community pharmacies and patient support groups. For people with longterm conditions, this involves working in partnership to understand
patients' mental and social needs as well as physical. Many patients will benefit from training in managing their condition, as well as connections
to care and support services in the community.
Prevention
Some practices are fostering links with their local community and launching new programmes to improve population health and prevent disease.
This spans a range of activities, including health education, promoting healthy eating and physical activity, and influencing other aspects of public
health. A common feature is a focus on communities helping themselves, with statutory services providing support.
Patient online
Technology changes are enabling patients to access their personal record online, through web portals and a growing number of health apps for
mobile phones. This makes common transactions such as ordering a repeat prescription quicker for the patient and for practice staff. It also
allows patients to become better informed about their health and care, and to play a more active role. With explanation and support, patients and
their carers are able to check test results, the progress of investigations and referrals, read and share their care plan, and enter details of home
monitoring, such as blood pressure, weight, and sugar tests. As well as being popular with patients, GP practices are reporting a reduction in
workload as a result of patients using these online services.
Acute episodes
Practices are increasingly involved in supporting patients with minor ailments to care for themselves. This often includes providing advice and
signposting to services provided by community pharmacy. Education also plays a part, with growing numbers of practies contributing to efforts to
teach people about the best ways to seek help when ill. This often begins with engagement in local primary schools.
Longterm conditions
For people with longterm conditions, a more proactive approach to care is being adopted, alongside a focused effort to help people play a more
active role in monitoring and managing their condition. Initiatives include supporting people to access their full medical record online, the use of
health coaching in clinical consultations and the provision of training and support in the community, aiming to build the knowledge, skills and
confidence for patients and carers to manage their condition. This builds patients’ own assets and quality of life, as well as reducing their
dependence on services such as the general practice.
53. #GPforwardview
Booking and cancelling
of appointments
Ordering of
repeat prescriptions
Access to
GP records
What is Patient Online?
Over 97% of all practices in England are currently offering these online
services to their patients. This was a requirement in last year’s GP
contract.
This year, the BMA and NHS agreed that all practices should aim to get
at least 10% of their patients signed up for online services by the 31st of
March 2017.
In the South region 64.2% of practices are already
offering online services.
54. Why should I do it?
Convenient way for patients to contact the
practice 24/7
Reduces footfall
Frees up phone lines for other patients
Reduces the amount of no shows
More efficient prescription process and less
prescription waste
Increases patient satisfaction and self care
Frees up valuable time for other essential tasks
55. New promotional materials available
Patient Online GP online services
Order promotional materials, including posters, patient guides,
leaflets, balloons, bunting and appointment cards, for free via
www.england.nhs.uk/materialsforpatient/
57. #GPforwardview
10 High Impact Actions to release time for care
Innovations from around England
that release time for GPs to do
more of what only they can do.
bit.ly/gpcapacityforum
bit.ly/gpcapacityforum
58. #TimeforCare
www.england.nhs.uk/gp
Local Time for Care
programmes
• Bespoke 9-12 month
programme to support a group
of practices to implement
innovations that release time
for care.
• Training for reception and
clerical staff, for active
signposting and document
management (£45m over 5
years).
• Funding towards purchasing
online consultation systems
(£45m over 4 years, from
2017).
• CCG transformational
support (£171m over 2 years,
from 2017).
General Practice
Improvement Leaders
• At least 400 free places a
year for three years.
• Skills and confidence in
designing and implementing
improvements within the
practice rapidly and
sustainably.
• RCGP Supporting
Federations Network and
NHS Collaborate (NAPC &
NHS Alliance) for leaders of
at-scale primary care.
• Funding facilitated peer
networking for practice
managers of all 7,800
practices, with support to
develop professional skills.
• 24 regional GPFV roadshows
• 30 local High Impact Actions
showcase events
• Web resources (60 and
growing)
• Fortnightly webinars
• Network of champions
10 High Impact Actions
to release time for care
59. #GPforwardview
Associated funding
CCG transformational support
• 2017-2019, CCGs to spend at least £3/patient to support
transformation of primary care services for the future
• typical uses: backfill for development, leadership development,
OD for federations
Training for clerical & reception staff
• 5 year fund: total 80p/patient (eg £8,000 for 10,000 list practice)
• 2016/17 portion allocated to CCGs Sept 2016
• Full information: www.england.nhs.uk/gp/gpfv/redesign/gpdp/reception-
clerical/
Online consultations
• 4 year fund: total 80p/patient
• First portion in Apr 2017
• Full information:
www.england.nhs.uk/gp/gpfv/redesign/gpdp/consultation-systems/
60. #TimeforCare
www.england.nhs.uk/gp
Local Time for Care
programmes
• Bespoke 9-12 month
programme to support a group
of practices to implement
innovations that release time
for care.
• Training for reception and
clerical staff, for active
signposting and document
management (£45m over 5
years).
• Funding towards purchasing
online consultation systems
(£45m over 4 years, from
2017).
• CCG transformational
support (£171m over 2 years,
from 2017).
General Practice
Improvement Leaders
• At least 400 free places a
year for three years.
• Skills and confidence in
designing and implementing
improvements within the
practice rapidly and
sustainably.
• RCGP Supporting
Federations Network and
NHS Collaborate (NAPC &
NHS Alliance) for leaders of
at-scale primary care.
• Funding facilitated peer
networking for practice
managers of all 7,800
practices, with support to
develop professional skills.
• 24 regional GPFV roadshows
• 30 local High Impact Actions
showcase events
• Web resources (60 and
growing)
• Fortnightly webinars
• Network of champions
10 High Impact Actions
to release time for care
www.england.nhs.uk/gp
61. #GPforwardview
10 High Impact Actions to release time for care
Innovations from around England
that release time for GPs to do
more of what only they can do.
bit.ly/gpcapacityforum
Consultation audit
www.primarycarefoundation.co.uk
/audit-tool.html
62. #GPforwardview
Running an effective & efficient practice
What are the challenges? What's worked for you?
1. Managing the business
2. Managing the team
3. Prescription requests
4. Incoming clinical correspondence
5. Test results
6. Using technology (eg Patient Online, etc)
7. Active signposting
8. Freeing up GP appointments (other ideas)
69. @robertvarnam
Where are we heading?
What size should we be?
How do we realise the benefits of scale?
What capabilities will we need?
70. @robertvarnam
Where are we heading?
What size should we be?
How do we realise the benefits of scale?
What capabilities will we need?
71. @robertvarnam
STP footprint: 300k-2m
Workforce & infrastructure planning
Large scale service reconfiguration
Major partnerships & shifts in priority
MCP: 100-350k
Organisational infrastructure & governance
Specialist staff & services
Employment & career development
Model design (population management, care models)
Strategic partnerships
Hub/Home: 30-60k
Acute care
Locality-tailored services
Shared MDT
Place of ‘belonging’
Core team: 3-4k
Coordinated, complex
multidisciplinary care
Continuity
72. @robertvarnam
Where are we heading?
What size should we be?
How do we realise the benefits of scale?
What capabilities will we need?
73. @robertvarnam
Where are we heading?
What size should we be?
How do we realise the benefits of scale?
What capabilities will we need?
77. #GPforwardview
Planning
• Workforce
• Infrastructure development
• Service reconfiguration
• Public health
Provision
• Acute care
• Community pharmacy
• Dentistry
• Optometry
• Social care
• Housing
• Welfare
• Voluntary sector
78. #GPforwardview
Traditional healthcare roles
• Pharmacists
• Specialist nurses
• Physiotherapists
• MH therapists
• Paramedics
Wellbeing workers
• Social workers
• Care navigators
• Health trainers & coaches
• Welfare advisors
81. @robertvarnam
Where are we heading?
What size should we be?
How do we realise the benefits of scale?
What capabilities will we need?
82. @robertvarnam
Where are we heading?
What size should we be?
How do we realise the benefits of scale?
What capabilities will we need?
83. @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
Business
Team leadership
Operations
management
H R
I T
At-scale
working
Governance
Contracts
Workforce
Business
intelligence
Capabilities for the future
Interdependent capabilities for leaders & organisations
84. #TimeforCare
www.england.nhs.uk/gp
Local Time for Care
programmes
• Bespoke 9-12 month
programme to support a group
of practices to implement
innovations that release time
for care.
• Training for reception and
clerical staff, for active
signposting and document
management (£45m over 5
years).
• Funding towards purchasing
online consultation systems
(£45m over 4 years, from
2017).
• CCG transformational
support (£171m over 2 years,
from 2017).
General Practice
Improvement Leaders
• At least 400 free places a
year for three years.
• Skills and confidence in
designing and implementing
improvements within the
practice rapidly and
sustainably.
• RCGP Supporting
Federations Network and
NHS Collaborate (NAPC &
NHS Alliance) for leaders of
at-scale primary care.
• Funding facilitated peer
networking for practice
managers of all 7,800
practices, with support to
develop professional skills.
• 24 regional GPFV roadshows
• 30 local High Impact Actions
showcase events
• Web resources (60 and
growing)
• Fortnightly webinars
• Network of champions
10 High Impact Actions
to release time for care
www.england.nhs.uk/gp
85. @robertvarnam
Where are we heading?
What size should we be?
How do we realise the benefits of scale?
What capabilities will we need?
Implications
for me?
87. #GPforwardview
Connect with other practice managers
Join a network
Write up one of successes
Sign up for a course
Do some eLearning
Self-directed reading / viewing
Your personal development
89. #GPforwardview
Preparation
Aligning plans, federation
development, local champions
Online consultation systems (bursaries from 2017)
Reception & clerical staff training (bursaries from 2016)
Launch
event
Development Advisor Support
Learn from innovators
General Practice Improvement Leaders Programme
CCG investment & support
Your Time for Care programme
Showcase
event
Productive General Practice
90. #GPforwardview
General Practice Improvement Leaders programme
Aim: Skills development
Build capabilities and confidence to support colleagues
in implementing change in practices
To ensure every locality has a local improvement
facilitator who can access both local and national
resources in the future
Fundamentals
of change and
improvement
(2-day session)
Human
Dimensions of
change
(2 x 1-day sessions)
Facilitation
skills
(2 x 1-day
sessions)
Primary care improvement community
Your own change project
91. #GPforwardview
Preparation
Aligning plans, federation
development, local champions
Online consultation systems (bursaries from 2017)
Reception & clerical staff training (bursaries from 2016)
Launch
event
Development Advisor Support
Learn from innovators
General Practice Improvement Leaders Programme
CCG investment & support
Your Time for Care programme
Showcase
event
Productive General Practice
www.england.nhs.uk/gpdp
PREP EACH TIME:
Who’s here – slide 4
Table numbers for world café
https://prezi.com/skbt9gedr0_i/practice-index/?utm_campaign=share&utm_medium=copy
Polls
Aims: provide updates, clarify information, answer questions .. ultimately, so you can plan yourself
So why are people talking about change? It’s partly about the pressure we’re under right now, and partly about the huge opportunity to do something better. And, for once, the same changes that would help with one are also necessary for the other.
2% population growth /yr
2.5% inc in consultations every year since 2007
GP numbers grown by 5,000 FTEs in past 10y - but hospital consultant numbers have roughly tripled
At the heart of the case for change is not the workload of practices – important though that is – it is the needs of patients, and they way they are changing. When the NHS was founded, its purpose was fairly simple. Every now and then, people got ill. When they did, they consulted their doctor. If it was a straightforward problem, they would give a prescription, the person would get better, return to work and, in a year or two, they might need the doctor again. If it was less straightforward, they would be referred to a clever doctor – who would give a prescription or cut out the offending part. The patient would then get better, return to work, and, in a year or two, they might become ill again.
That accounted for the majority of the anticipated work of the NHS. And, for some patients, that’s still the kind of care that’s needed.
However, a growing proportion of our work is fundamentally different. This now seminal chart illustrates the central fact underlying the quantitative and qualitative change in the work of primary care. It illustrates the rise in multimorbidity with age. As people get older, they have more simultaneous longterm conditions. So that, by the age of 75, for example, at least a third of people are living with four or more LTCs. And, as our demography changes, the proportion of older people increases. Dealing with longterm conditions already accounts for over half of work in primary care. It is set to increase.
And, crucially, this represents a qualitative change in the nature of work. These are not people who visit the GP every year or two to get cured of their problem. These are people with problems that we cannot cure – they are living with multiple issues which will not go away, and they visit the GP six, seven, eight or more times a year. At least. Furthermore, the more simultaneous problems someone has, or the greater their frailty, the less helpful it is to pass their care to a doctor specialising in one part of the body. These people need treating as people, not diseases.
So the population of people who need what only primary care can offer has grown, the amount of time they need has grown – and both are set to continue growing. This is the chief case for change in primary care, the pressure of patients’ needs.
This is not a blip requiring a short-term correction to the priorities of the NHS. It is a fundamental shift which requires every developed nation on earth to turn away from what Muir Gray has termed the ‘century of the hospital’, and place the emphasis where the population’s need is.
Stabilisation AND transformation
The START
So why are people talking about change? It’s partly about the pressure we’re under right now, and partly about the huge opportunity to do something better. And, for once, the same changes that would help with one are also necessary for the other.
Talk til 1:15pm
15min to 1:30pm
30min: 1:30 – 2:00pm
56 GPs rated 5,128 consecutive consultations to identify which might have been avoided.
Outpatients: this includes patients re-consulting with the GP because they missed an appointment and were discharged automatically; outpatient prescriptions which were not issued by the hospital; and investigations and other follow-up activity included in the outpatient plan but which the GP practice were asked to undertake.
56 GPs rated 5,128 consecutive consultations to identify which might have been avoided.
Outpatients: this includes patients re-consulting with the GP because they missed an appointment and were discharged automatically; outpatient prescriptions which were not issued by the hospital; and investigations and other follow-up activity included in the outpatient plan but which the GP practice were asked to undertake.
56 GPs rated 5,128 consecutive consultations to identify which might have been avoided.
Outpatients: this includes patients re-consulting with the GP because they missed an appointment and were discharged automatically; outpatient prescriptions which were not issued by the hospital; and investigations and other follow-up activity included in the outpatient plan but which the GP practice were asked to undertake.
56 GPs rated 5,128 consecutive consultations to identify which might have been avoided.
Outpatients: this includes patients re-consulting with the GP because they missed an appointment and were discharged automatically; outpatient prescriptions which were not issued by the hospital; and investigations and other follow-up activity included in the outpatient plan but which the GP practice were asked to undertake.
If that’s the WHAT, this is the HOW
These have come from practices around England
* SEE HANDOUT *
A growing collection – submit your own examples and questions.
Introduce new ways of working which enable staff to work smarter, not just harder. These can reduce wasted time, reduce queues, ensure more problems are dealt with first time and that uncomplicated follow-ups are less reliant on GPs consultations.
Match capacity with demand
Appointment systems and staff rotas are designed in order to ensure sufficient capacity is available to match patterns of demand as they vary through the week and the year. This requires an ongoing system of measuring demand and adjusting capacity accordingly. It may also involve scheduling routine work (eg annual reviews and clinical audit) for less busy times of the year. The benefits are a reduction in delays for appointments, less stress for staff and patients, and better access.
Efficient processes
The application of Lean principles to measure, understand and improve common processes in the practice, in order to reduce waste and errors. Typical targets include clinical follow-up protocols, processing of letters and test results, requests from patients, staff messages and team decision making. Staff themselves often have a wealth of ideas about ways in which processes could be improved to release time. Practices who take a systematic approach to identifying and testing these generally find that this improves care for patients as well as freeing staff time for other things. The use of pre-prepared plans for managing common simple follow-up processes can improve their reliability and efficiency, freeing GP time. Common examples include management of hypertension, monitoring of tests after the initiation of new medication, and adjustment of medication doses to reach a target.
Productive environment
The physical layout within the practice is assessed for its effect on staff's productivity, and improvements are introduced which reduce wasted time. The Lean technique of 5S is the best known approach for doing this. Additionally, work can be undertaken to ensure that staff can access information needed to support their work quickly. This reduces time spent searching for information and can improve patient safety as well.
Take every opportunity to support people to play a greater role in their own health and care. This begins before the consultation, with methods of signposting patients to sources of information, advice and support in the community. Common examples include patient information websites, community pharmacies and patient support groups. For people with longterm conditions, this involves working in partnership to understand patients' mental and social needs as well as physical. Many patients will benefit from training in managing their condition, as well as connections to care and support services in the community.
Prevention
Some practices are fostering links with their local community and launching new programmes to improve population health and prevent disease. This spans a range of activities, including health education, promoting healthy eating and physical activity, and influencing other aspects of public health. A common feature is a focus on communities helping themselves, with statutory services providing support.
Patient online
Technology changes are enabling patients to access their personal record online, through web portals and a growing number of health apps for mobile phones. This makes common transactions such as ordering a repeat prescription quicker for the patient and for practice staff. It also allows patients to become better informed about their health and care, and to play a more active role. With explanation and support, patients and their carers are able to check test results, the progress of investigations and referrals, read and share their care plan, and enter details of home monitoring, such as blood pressure, weight, and sugar tests. As well as being popular with patients, GP practices are reporting a reduction in workload as a result of patients using these online services.
Acute episodes
Practices are increasingly involved in supporting patients with minor ailments to care for themselves. This often includes providing advice and signposting to services provided by community pharmacy. Education also plays a part, with growing numbers of practies contributing to efforts to teach people about the best ways to seek help when ill. This often begins with engagement in local primary schools.
Longterm conditions
For people with longterm conditions, a more proactive approach to care is being adopted, alongside a focused effort to help people play a more active role in monitoring and managing their condition. Initiatives include supporting people to access their full medical record online, the use of health coaching in clinical consultations and the provision of training and support in the community, aiming to build the knowledge, skills and confidence for patients and carers to manage their condition. This builds patients’ own assets and quality of life, as well as reducing their dependence on services such as the general practice.
A growing collection – submit your own examples and questions.
Scenarios
Scenarios
A growing collection – submit your own examples and questions.
World Café – 2 sessions
Til 2:45 (break)
Til 3:10pm
15min til 3:25
Resilience
Economies of scale
System partnerships
Skillmix
Innovation and improvement
Staff development
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 Minister’s 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.
Very flexible approach, so each programme can be tailored to the needs and interests of local practices. Well worth starting to talk about this with others across the CCG soon, but no rush – it’s a 3y programme. Much more info at www.england.nhs.uk/gpdp and in the fortnightly “find out more” webinars.
How could you align this with other things … eg other development plans / teams, practice resilience activity?
Very flexible approach, so each programme can be tailored to the needs and interests of local practices. Well worth starting to talk about this with others across the CCG soon, but no rush – it’s a 3y programme. Much more info at www.england.nhs.uk/gpdp and in the fortnightly “find out more” webinars.
How could you align this with other things … eg other development plans / teams, practice resilience activity?
Speed dating: to 4:20pm 4 or 5 x5min
PREP EACH TIME:
Who’s here – slide 4
Table numbers for world café
https://prezi.com/skbt9gedr0_i/practice-index/?utm_campaign=share&utm_medium=copy
Polls