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?

1. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
• Dr Robert Varnam
Clinical lead for primary care transformation
• Sustainable Improvement Team
@robertvarnam
Primary Care Networks
bit.ly/20181002liverpool
Why? How?

2. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
Primary Care Networks
bit.ly/20181002liverpool
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls
Where to
start?

3. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
Primary Care Networks
bit.ly/20181002liverpool
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls
Where to
start?

4. @robertvarnam #GPforwardview
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 #GPforwardview
Continuity
Community focussed
Holistic
Comprehensive
STRENGTHS OF PRIMARY CARE
Central
Constraints on delivering
the full potential:
Demand >> workforce + funding
Practices are set up to provide mostly
medical care (reactive, individual >
proactive, population focused)
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 #GPforwardview
Specialists
Community
services
1948 CARE

7. @robertvarnam #GPforwardview
Self
Care
Broader skillmix
Self
management /
social
prescribing
Emergency
care
Collaboration
with specialists
At scale
FUTURE CARE

8. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
Primary Care Networks
bit.ly/20181002liverpool
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls
Where to
start?

9. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
Primary Care Networks
bit.ly/20181002liverpool
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls
Where to
start?

10. @robertvarnam #GPforwardview
Primary care networks: Opportunities for practices

11. @robertvarnam #GPforwardview
Primary care networks: Opportunities for practices

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

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

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

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

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

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

18. @robertvarnam #GPforwardview

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

20. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
Primary Care Networks
bit.ly/20181002liverpool
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls
Where to
start?

21. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
Primary Care Networks
bit.ly/20181002liverpool
Why? How?
Benefits
for
practices
Benefits
for
patients
Avoiding
common
pitfalls
Where to
start?

22. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
Primary Care Networks
bit.ly/20181002liverpool
How?
Avoiding
common
pitfalls
Where to
start?
Circular discussions about size
Putting form first

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

24. @robertvarnam #GPforwardview
System: 0.5-3m
System partnerships for large scale change
Workforce & infrastructure planning
Major partnerships & shifts in priority
Place: 100-900k
Strategic partnerships
Organisational development infrastructure
Corporate support
Career development
Population wellbeing
Neighbourhood: 30-60k
Acute care
Shared MDT
Population management
Business functions
Team: 4-30k
Place of belonging
Doing the right thing at the right scale
Microteam: 2-500
Personal continuity of care

25. @robertvarnam #GPforwardview
Purpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > form
Success depends more on:
Shared purpose
Culture for collaboration
Capabilities for improvement and leadership
Purpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > form

26. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
 Pick something to achieve
 Do it together
 Build relationships & capabilities as you go
 Build structures & contracts to sustain new
ways of working
So …?
bit.ly/20181002liverpool