Transforming primary care (integrated care)
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Presentation at Commissioning Live, London 05/03/15 Here I consider where we're up to in the NHS in England with establishing integrated care built on the strengths of the primary care team. Reflecting on the NHS Five Year Forward View and the Call to Action on General Practice, I conclude there is much to be done still. I use our recent experience of the Prime Minister's Challenge Fund to suggest ways in which CCGs can accelerate primary care transformation.
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Transforming primary care (integrated care)
- 1. www.england.nhs.uk Transforming primary care Dr Robert Varnam MRCGP PhD MSc Head of general practice development robert.varnam@nhs.net @robertvarnam @NHSEngland Commissioning Live, London 05.03.15
- 4. www.england.nhs.uk Multispeciality Community Providers GP practice GP practice GP practice GP practice GP practice GP practice GP practice GP practice Specialists Pharmacists Community provider SC provider VCS VCS VCS MH Trust VCS VCS VCS
- 5. www.england.nhs.uk Primary and Acute Care Systems Community provider SC provider VCSMH Trust Acute provider GP practice GP practice GP practice GP practice GP practice GP practice GP practice GP practice
- 6. Health & wellbeing-promoting care Responsive access Consistently high quality Holistic, personalised, proactive, coordinated care bit.ly/c2aGP
- 8. www.england.nhs.uk ๏ฑ Create shared purpose for change ๏ฑ Build capacity & capability How? @robertvarnam @NHSEngland
- 9. www.england.nhs.uk ๏ผ Create shared purpose for change ๏ฑ Build capacity & capability How? @robertvarnam @NHSEngland
- 13. www.england.nhs.uk ๏ผ Create shared purpose for change ๏ผ Build capacity & capability How? @robertvarnam @NHSEngland
- 14. www.england.nhs.uk Development areas Transformation Leadership & Strategy Funding (change capacity, double running) Contract Service spec Outcomes spec Mechanisms Premises Service spec Outcomes spec Mechanisms Partnerships Providers, inc VCS Patient, public, political Information Single patient record Business intelligence Service redesign Care models & pathways Clinical governance Corporate Entity & governance Finance Ops management HR Support through change T&Cs Recruitment Workforce New & changed roles Team redesign Role redesign @robertvarnam @NHSEngland
Editor's Notes
- Please get in touch โ we need to hear your ambitions, successes and challenges. Weโre committed to finding more ways to promote, support and sustain improvement, innovation and transformation in wider primary care.
- Three years ago I had the privilege of co-writing the NHS Future Forum report on integrated care. While a privilege, it was also saddening. As we explored the worldwide evidence and met with leaders in England passionate about established integrated care, I saw again and again two failures. Firstly, there has been a repeated failure to build really effective collaboration between stakeholders. Many joint strategies have been published, often with detailed plans. In a number of places, organisational mergers have been agreed. Yet, again and again, these have been disappointing in that care for patients has not changed nearly as much as hoped. Cultures have remained different, or even at odds with each other. Teams have remained separate. Behaviours have not changed. Secondly, primary care has been largely absent. Itโs almost as though planning has begun with the sentence โassuming general practices arenโt going to be part of the solution, how do we deliver more joined up care for local people?โ. Yet primary care is, in many respects, at the heart of the health and care system for patients. And without its wholehearted involvement, very few of our system ambitions will be realised.
- Thatโs why Iโm so pleased the NHS is taking a fresh look at how to maximise the potential contribution of primary care. The NHS Five Year Forward View has presented a powerful and attractive vision of the future and the priorities which the whole system will need to grapple with in order to achieve it. Iโm really proud of it, particularly the renewed focus on improving population wellbeing, creating a new kind of partnership with patients and unleashing the potential of primary care at the heart of most peopleโs care.
- One of the aspects of the Forward View which has attracted most attention is the description of four areas where we may need to rethink key aspects of organisational form. MCPs and PACS are two. Both are examples of more integrated organisations.
- The point here is not to assert that form can deliver function, but to acknowledge that form can be very helpful in both establishing and sustaining new ways of working. The goal is the care for patients โ a more integrated experience, providing faster, more seamless access to joined-up holistic care closer to home. Weโre right in the middle of the process of selecting forerunners who weโll work with to test whatโs possible and whatโs necessary to achieve it.
- We make no bones about the fact that there are huge implications for primary care in all of this. The Forward View is great news for primary care, but itโs very clear that this is not business as usual, or even โmore of the sameโ โ radical change (as well as improvement and support) is needed. So, from the perspective of primary care, what kind of future do we see? NHS Englandโs Call to Action on general practice, launched in the summer of 2013, made a helpful contribution by engaging patients, providers and commissioners in describing what kind of care we wanted, and what would be needed to achieve it. The emerging findings, describe four ambitions for the future โ areas where we should aim to deliver more of the promise of great primary care.
- Right now, general practice is under tremendous pressure. NHS England recognises that current trends (eg rising workload, falling relative investment, workforce challenges) cannot continue. If a safe service is to continue to be provided โ let alone significant service change โ we will need to support general practice. The Forward View therefore describes a โnew dealโ for primary care. We should also acknowledge that the demands and constraints under which general practice has been operating in recent years often make it very difficult for practices to raise their heads up from the immediate task in front of them, to consider bigger issues about a different future.
- So how can we collectively promote, support and sustain the kind of change weโre outlining for primary care? Two areas have stood out as we have listened to commissioners and practices over the last two years, and provided practical support in programmes such as the Prime Ministerโs Challenge Fund: creating shared purpose for change, and building the right capacity and capability for service redesign.
- So how can we collectively promote, support and sustain the kind of change weโre outlining for primary care? Two areas have stood out as we have listened to commissioners and practices over the last two years, and provided practical support in programmes such as the Prime Ministerโs Challenge Fund: creating shared purpose for change, and building the right capacity and capability for service redesign.
- The NHS Change Model contains โeverything we know about successful change in one placeโ. It emphasises the power of created a shared purpose for change, as a starting point/foundation, as well as an ongoing โcentre of gravityโ for all other change components. Leaders who intentionally foster a strong sense of โusโ, connect with peopleโs values and create momentum for change consistent with those, find that it is easier to start and sustain large scale change.
- Yet, when I reflected recently on the conversations Iโve had with the leaders of networks and federations of GP practices in recent months, the overriding impression was of a lack of clear purpose. Quite a lot of work had been done to establish agreements and even new organisations, but it wasnโt quite clear why. Some new federations have begun asking whether theyโve formed for anything more than self-preservation or competitive advantage. Some well known federations have even been asking themselves if they should wind down. In fact, when Iโve supported practices in a CCG to agree priorities for the future, the sad truth is that many seem to have lost their sense of purpose altogether. Or else theyโre toiling just to survive another day, week or month.
- We need to help practices look up from the daily grind, and rediscover their purpose, why they came into this in the first place. We can then create an attractive vision of the future thatโs worth committing to, and then connect that to the changes that need to occur in daily work. Thatโs a compelling purpose for change.
- So how can we collectively promote, support and sustain the kind of change weโre outlining for primary care? Two areas have stood out as we have listened to commissioners and practices over the last two years, and provided practical support in programmes such as the Prime Ministerโs Challenge Fund: creating shared purpose for change, and building the right capacity and capability for service redesign.
- Thank you.