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.

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GENERAL PRACTICE FORWARD VIEW
Dr Robert Varnam
Head of general practice development
@robertvarnam
Improving access at scale
Top ten tips …

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Access at-scale: top ten tips

3. @robertvarnam #GPforwardview
Access at-scale: top ten tips

4. @robertvarnam #GPforwardview
Access at-scale: top ten tips

5. @robertvarnam #GPforwardview
Access at-scale: top ten tips

6. @robertvarnam #GPforwardview
Access at-scale: top ten tips
Secure the capacity needed
• protect time for leaders to lead
• start succession planning early
Choose the right approach
• leading people who don’t work for you
• lead through commitment to values & vision
• coproduce plans (people commit where they
have contributed)
• share responsibility widely

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Access at-scale: top ten tips
Secure the capacity needed
• this is not a hobby
• few people have ‘spare time’
• setup takes more time
Choose the right capabilities
• business intelligence
• HR and workforce development
• IT and information governance
• patient and public engagement
• financial planning and governance
• service redesign
• portfolio, programme and project
management

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Access at-scale: top ten tips
Organisational form
• single legal essential for most large-scale
NHS commissions
• culture & processes within / under a single
entity are then more important than form
Size
• find most natural size for each function
• expect a ‘nested’ approach
Location
• ensure travel is as easy as possible for
patients
• consider premises suitability & costs
Function before form

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Access at-scale: top ten tips
Access to records
• essential
• learn from others’ consent models &
information sharing agreements
• consider single systems as alternative to
bridges
• slower than you think
Tech-enabled care
• consider systems to support self care, more
efficient transactions and ‘remote’
consultations
• consider testing demand for video
consultations before large scale investment

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Access at-scale: top ten tips
Engage patients for …
Setting priorities
• NHS belongs to us all
• people surprise you
Offering new solutions
• patients can see different opportunities
• patients think beyond medicine
Contributing work
• the community can be part of the solution

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Access at-scale: top ten tips
Potential partners
• 111 services, OOH, ambulance trusts, A&E,
community pharmacy, voluntary sector,
schools
Benefits
• Shaping demand
• Clarity for patients
• Reducing overlap or duplication of supply
• Improved continuity of care
…design deliberately to achieve the benefits

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Access at-scale: top ten tips
Planning
• model scenarios for costs, test assumptions
• agree sharing model in advance
Reporting
• prepare for comprehensive & detailed
accounting
Procurement
• consider specialist input

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Access at-scale: top ten tips
Clinical governance
• accountability structure
• processes
• protected time
CQC registration
• much simpler
• allow time
Indemnity cover
• include in cost modelling
• clarify records access
• shop around
• consider single provider & group schemes
• provide informed choice re exclusions & run-
off cover

14. @robertvarnam #GPforwardview
Access at-scale: top ten tips
Setting priorities
• needs analysis
• geographical & demographic segments
• inequalities
Measurement to motivate
• rapid realtime measures of progress
Measurement for accountability
• activity
• outcomes
• safety
• costs
Avoid manual data collection wherever possible

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Access at-scale: top ten tips
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