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?

1. @robertvarnam@robertvarnam
• Dr Robert Varnam
Clinical lead for primary care transformation
• Sustainable Improvement Team
@robertvarnam
Primary Care Networks
bit.ly/20181204birmingham
Realising the potential

2. @robertvarnam@robertvarnam
Primary Care Networks
bit.ly/20181204birmingham
The benefits
for patients & practices
How to realise the benefits
(common pitfalls)

3. @robertvarnam@robertvarnam
Primary Care Networks
bit.ly/20181204birmingham
The benefits
for patients & practices
How to realise the benefits
(common pitfalls)

4. @robertvarnam
Continuity Accessible personal
care built on a relationship from cradle
to grave
Community focussed Responsible for
a registered population, improving wellbeing
Holistic Dealing with the patient as a
person not a disease or part of the body
Comprehensive Handling wide range
of problems, managing clinical uncertainty
Strengths of primary care
Central Coordinating and connecting
other teams, referring where appropriate

5. @robertvarnam
Continuity
Community focussed
Holistic
Comprehensive
Strengths of primary care
Central
Constraints on delivering
the full potential:
Demand >> workforce + funding
Practices set up to provide mostly
medical care
Generally work in a reactive way
Hard to coordinate other inputs and
‘pull in’ specialist support
Too small and isolated to have
significant impact on population or
system
Primary care doesn’t need reinventing, but liberating to deliver its potential

6. @robertvarnam
Continuity
Community focussed
Holistic
Comprehensive
Unleashing more of the potential
Central
Care:
• Stronger focus on wellbeing
• More proactive, planned and
coordinated care for complex needs
• Empower patients for self care
• Technology serving patients and staff
Teams:
• Broader skillset
• Big enough to impact the population
and be a system leader
• Closer partnerships with community
pharmacy, community services, mental
health, voluntary sector, social care
• Stronger business functions, eg HR,
finance, informatics
• Specialist improvement capabilities
Networks of practices across England are already introducing changes to
unleash more of primary care’s potential…

7. @robertvarnam
Primary care networks: Opportunities for practices

8. @robertvarnam
Primary care networks: Opportunities for practices

9. @robertvarnam
Primary care networks: Opportunities for practices
 Staff pooling
• nurses, reception & clerical staff,
sessional GPs … internal ‘bank’
 Overflow support
• phone consultations
• access hub (phone +/- face-to-face)
• home visiting

10. @robertvarnam
Primary care networks: Opportunities for practices
 Purchasing
• Indemnity bulk purchasing
• Supplies & utilities
 Shared functions
• CQC registration
• Accounting
• Policies & procedures
• Procurement
• Correspondence management
• IM&T (eg support & maintenance, intranet, web,
social media)
 Specialist functions
• HR
• Finance
• Clinical governance
• Business intelligence

11. @robertvarnam
Primary care networks: Opportunities for practices
 Planning
• Workforce
• Infrastructure development
• Service reconfiguration
• Public health
 Provision
• Acute care
• Community pharmacy
• Dentistry
• Optometry
• Social care
• Housing
• Welfare
• Voluntary sector

12. @robertvarnam
Primary care networks: Opportunities for practices
 Traditional healthcare roles
• Pharmacists
• Specialist nurses
• Physiotherapists
• MH therapists
• Paramedics
 Wellbeing workers
• Social workers
• Care navigators
• Health trainers & coaches
• Welfare advisors

13. @robertvarnam
Primary care networks: Opportunities for practices
 Sharing ideas
 Testing new ideas
 QI expertise
 Patient engagement
 Analytics
• Population health analytics
• Priority setting
• Benchmarking
• Realtime measurement
 Project management
 Research participation

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

15. @robertvarnam
Primary care networks: Opportunities for practices
Benefits are not automatic
Some mergers achieve little
Some ‘alliances’ achieve much

16. @robertvarnam@robertvarnam
Primary Care Networks
bit.ly/20181204birmingham
The benefits
for patients & practices
How to realise the benefits
(common pitfalls)

17. @robertvarnam
What size should we be?
 Personal focus
 Clarity
 Commitment
 Agility
 Population focus
 Alignment
 Priorities
 Partnerships
20 100
Don’t accept
either / or
solutions

18. @robertvarnam
System: 1m +
System partnerships for large scale change
Workforce & infrastructure planning
Major partnerships & shifts in priority
Place: ~250-500k
Strategic partnerships
Organisational development infrastructure
Corporate support
Career development
Population wellbeing
Neighbourhood: ~50k
Acute care
Shared MDT
Population management
Business functions
Team: 10-20k
Place of belonging
Doing the right thing at the right scale
Microteam: 2-500
Continuity for complex needs

19. @robertvarnam
Building a successful primary care network…
Purpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > form

20. @robertvarnam
Building a successful primary care network…
Purpose > function > form
Many federations have form without an inspiring or practical purpose.
Simply talking won’t move you forward.
 Pick something to improve – eg managing workload better
 Get started on it together
 Build capabilities, processes & structures to serve the new
ways of working which emerge
So …
bit.ly/20181204birmingham