Meeting name: Ealing PCCCPrimary Care and NWL’s ambitions • A vision and our aspirations for primary care across NWL • The delivery model, and models of care that reflect the

Item: 3

Meeting name: Ealing PCCC

Date Wednesday, 22 May 2019

Presenter Sue Jeffers – NW London CCGs

Author/s NW London CCGs

Responsible Director

NW London CCGs

Clinical Lead Dr. Neville Purssell

Dr. MC Patel

Confidential Yes ☐ No Items are only confidential if it is in the public interest for them to be so

The Committee is asked to: Note the attached draft Primary Care Strategy for NW London

Strategic Objectives and Board Assurance Framework N/A

Summary of purpose and scope of report NW London has been asked by NHSE to prepare and submit a Primary Care Strategy. The attached draft has been prepared using existing local documentation, and with input from local stakeholders, in order to ensure submission by the initial deadline of 1 April.

The Strategy is now out for wider engagement and comment in the CCGs, including their Primary Care Commissioning Committees, and across NW London. We anticipate submitting a final version by end May, and would welcome the Committee’s views and comments on the attached draft.

What are the benefits of this project? Benefits for Practices:

• Greater resilience: by making the best use of shared staff, buildings and other resources, practices and the wider system can help to balance demand and capacity over time and thereby manage patient inquiries and requests as swiftly as possible

• Better work/life balance: with more tasks routed directly to appropriate

Title of paper Primary Care Strategy (Next Steps for Strategic Commissioning Framework) and Investment and Evolution

Item: 3

professionals, such as clinical pharmacists, social prescribers, and physiotherapists, patients can be offered a broader range of services, from the right professional, whose workload is manageable and who can therefore give undivided attention to their patient

• More satisfying work with each professional able to focus on what they do best • Improved care and treatment for patients by expanding access to specialist or

support services such as social care • Greater influence on the wider health system, leading to more informed decisions

about where resources are spent

Benefits for Patients: • More co-ordinated services where they do not have to repeat their story multiple

times

• Access to a wider range of professionals in the community, so they can get access to the people and services they need in a single appointment

• Appointments that work around their lives, with shorter waiting times and different ways to get treatment and advice including digital, telephone-based and face-to-face

• More influence when they want it, giving more say over how their health and care are planned and managed

• Personalisation with a focus on prevention and living healthily, recognising what matters to them and their individual strengths, needs and preferences

Benefits for the system • Co-operation across organisational boundaries and teams to allow better co-

ordination of services

• Wider range of services in a community setting, so patients do not need to be seen unnecessarily in the acute sector

• Developing a more population-focused approach to system-wide decision-making and resource allocation, drawing on primary care expertise as central partners

More resilient primary care, acting as the foundation of integrated systems

Patient, staff and stakeholder engagement Meetings scheduled with the Integrated Lay Partners Group. Additional CCG meetings.

Jargon buster N/A

Quality & Safety

The impact on quality and safety and patient services of implementing the strategy will be considered further at the point at which the strategy is finalised

Item: 3

Equality analysis

Equality, human rights and privacy impact analysis will be considered as part of implementing the strategy and will be considered further at the point at which the strategy is finalised

Finance and resources The financial implication of implementing the strategy will be considered further at the point at which the strategy is finalised

Risk Mitigating actions

The CCG does not meet the requirements of the changes in primary care

The strategy is being discussed and approved by the Primary, Community & Social Care Board in May

Supporting documents

Draft strategy

Conflict of interests

Following the review of the paper by the main co-ordinating team (secretary; committee chair and executive lead), have any potential conflicts affecting the membership been identified?

Yes ☐ No

If yes, please identify conflicted individual(s) and confirm what action is being taken, ticking all the actions that apply. If actions differ for more than one conflicted individual, please record this clearly by further naming each individual alongside each action that applies to them. Name and nature of conflict (describe): .…………………………………………………………………………………………… ……………………………………………………………………………………………………………

……………………………………………………………………………………………………………

Action taken: Please tick one

1. The paper has been withheld from the individual(s) concerned.

☐

Item: 3

2. The individual(s) will not attend the meeting where the paper

will be discussed. ☐

3. The paper is being shared; however, the individual(s) will not participate in discussion.

☐

4. The paper is being shared for discussion purposes; however the individual(s) will not participate in, or be present for the final decision

☐

For the avoidance of doubt, the use of the above chosen handling strategy will also be formally recorded by the secretary in the minutes of the meeting to confirm the action that was taken, which shall further be added to the CCG’s COI management actions log and made available online alongside the CCG’s register of decisions taken.

Governance, reporting and engagement Provide a brief overview of where this paper – or work in developing it – has been discussed. Signpost to where in the paper more detail on this can be found.

Name Date Outcome and where in the report can you find out more

CCG Primary Care Committees

April & May Noted

Primary, Community & Social Care Board in May

12/04/2019

17/05/2019

Noted

Lay Partners Group 07/05/2019 Useful commentary on key priorities for patients, and possible ways of taking these forward (eg, by ways of capturing PPG views at Primary Care Network level)

5/15/2019 1

DRAFT

North West London Primary Care Strategy

2019/20 plans and outline proposals to 2023/24

Initial Draft submitted to NHSE on 01/04/2019

Final Version due 01/06/2019 (following submission to CCG PCCCs)

V0.11 – 14 May 2019

5/15/2019 2 DRAFT 2

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Introduction

01

The Long Term Plan was released on 7 January 2019. Its goal is to support integration of care, and dissolve the divide

between primary care and community based health services. Primary care networks enable the provision of proactive,

accessible, coordinated and integrated care to improve outcomes for patients. Networks will be small enough still to

provide the person centred care valued by both patients and GPs, but large enough to have impact through deeper

collaboration between practices and others in the local health (community and primary care) and social care system.

In 2015, the ”Transforming Primary Care In London, Strategic Commissioning Framework”

(SCF) outlined the new patient offer centred around the three aspects of care that matter

most to patients: proactive care, accessible care and coordinated care. The ‘Next Steps to

the SCF’ (November 2018) evidences the role of collaborative working within Primary Care

and how the translation into Integrated Care Services will occur. It emphasises the

importance of strengthening collaborative working based on the five themes of 1)

Comprehensive population-based care, 2) Systems, information and quality improvement, 3)

Organisational capabilities, 4) Effective governance and stewardship and 5) Building and

leading collaborative system partnerships.

Purpose and overview of this document

This document builds on the CCGs Primary Care Strategies, the good

progress made in 18/19 and sets out NWL’s strategy for the development of

Primary Care from FY19/20 to FY23/24 in line with NHS England’s

requirement that this is detailed for every ICS. The document sets out:

• The alignment between the national and regional strategies for

Primary Care and NWL’s ambitions

• A vision and our aspirations for primary care across NWL

• The delivery model, and models of care that reflect the SCF

• A high-level roadmap to FY23/24

• The programme structures and governance to support this

• An overview of achievements made to date across the CCGs that

builds confidence in our ability to deliver

• A description of the strategic initiatives and enablers across NWL

that will ensure we get to where we aspire to be

North West London (NWL) has made significant progress during FY18/19 through each of its constituent CCGs’ Primary Care Strategies and ambitions to

deliver Primary Care at scale across the STP footprint. Since the publication of the NHS Long Term Plan, the NWL Health and Care Partnership has been

progressing plans to create a single Integrated Care System (ICS) across NWL, and has been supporting Primary Care across the CCG and borough

footprints to establish Primary Care Networks (PCNs) within the ICS.

5/15/2019 3 DRAFT 3

V0.11 – 14 May 2019

Contents

01 North West London Vision Strategic Primary Care Perspective 5

North West London vision for Primary Care 6

Care Delivery Model 8

05 Delivery Roadmap Primary Care Maturity Journey 14

Developing our Transformation Roadmap 15

04 Delivery Structures Structure & Governance 16-18

02 CCG Achievements To Date Snapshot of Local Progress 19-23

03 Strategic Initiatives & Enablers Overview and Key Aspirations 24-25

Quality & Safety Standards 26

Population Health Management 27-28

Contracting & Commissioning 29-30

Digital 31

Estates & Hubs 32

Workforce Planning 33-35

Public & Stakeholder Engagement 36

01 02 03 04 05 06

5/15/2019 4

DRAFT

Primary Care Strategy North West London Vision

5/15/2019 5 DRAFT 5

V0.11 – 14 May 2019

NWL Strategic Primary Care Perspective

Better recovery focused-care for mental health

Outstanding quality

Pri

ncip

les

Impeccable safety

VISION

Workforce • Digital • Estates • Finance • Comms & Engagement

Increased access to the right care in the right place

when in crisis

Safe, sustainable hospitals with best quality surgical and medical care

We want to give every child and

family the best start and continue to

support people to live healthy lives

We want to make sure there is care

and support when

you need it

If you do need to be in hospital, we

want you to receive high quality

care and spend the appropriate time

there

Improve patient and carer experience

Improve staff

experience

Improve population health

Improve value

Decrease unwarranted

variation

Sta

ndard

s

Better early detection and survivorship for cancer

Reduce health and wellbeing inequalities, healthy communities

Increase quality and safety of maternity and care

People with LTCs fully supported with their health

and care

Children have the best start in life

Enable

rs

Outc

om

es

start well live well age well

AIM

To support people closer to home in order to maximise independence and prevent deterioration in their health and wellbeing.

OUTCOME

Increase the proportions of people with long term conditions who are fully supported in the community and place of work and home,

and who make informed decisions about their health and care

We have developed our strategic clinical and care priorities in partnership with our clinicians, patients

and carers. Through our priority programmes of work we will be looking to deliver the outcomes above

Federation &

Network Development

Commissioning & Contracting Estates/ Hubs Digital

Workforce Planning

Priority

programmes and

projects

Our Health and Care Partnership vision in NW London is to create one integrated health and care system working together to maximise benefits to residents and staff. Primary Care Networks are at the heart of this vision. We will work together to transform the health and care landscape across North West London in order to achieve our shared vision; to deliver improved outcomes and patient experience; ensure a financially sustainable system; support professionals with their working challenges; and meet the expectations of patients, carers and the wider public.

Decrease premature mortality for people with long term conditions

Increase years of life lived in good health

Increase care coordinated around the individual, with informed, shared decision-

making

Increase proportion of people living independently

Improve navigation around the health and care system (eg, via social prescribing)

Improve our responsiveness to crisis care in the community

Improve patient experience in all areas

Reduce rates of harm caused by medication errors

Integrated Community

Care Outcomes

Primary

Care

Networks

01 02 03 04 05 06

Population Health Management

Public & Stakeholder Engagement

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NW London’s vision for Primary Care

Changing the way we work so that general practice teams build relationships with all other staff in their networks, and together create a partnership between professional s and people that empowers peoples ‘ control over their own health and delivers integrated whole person care to the key groups of people

Ensure each of our primary care networks has the tools they need to practice; modern estate, digital solutions, robust data, evidence based information easily to hand, and WSIC whole population profiles . Resources are targeted to support good and excellent practice and supports struggling practices and networks

Ensure our primary care networks work to a continuous quality improvement cycle that meets quality standards, gets rid of unwarranted variation, aims for all our practices to be good or outstanding for CQC, and standardises our care pathways to ensure consistent quality of, and improved access to services

Maximise the opportunity of general practice working to scale in collaboration with community and mental health providers to address the workforce and sustainability agendas, and to have excellent development opportunities available that allow full use of everyone's skills and abilities

Patient and Public Voice

General Practice is at the centre of how we deliver care, working with colleagues, patients and carers in Primary Care Networks, collaborating with partners, including our GP Federations, to support the delivery of an Integrated Care System and using technology that works for everyone. For NW London, if we are to achieve our ambition of whole person population-based care, we need a strong collective primary care voice - not just at the table when plans are made, but actively participating in leading this change.

01 02 03 04 05 06

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V0.11 – 14 May 2019

• By 30th September 2019 100% of Primary Care Networks will have carried out a maturity matrix

• 75% of practices provide on-line consultation by March 2020, and all patients will have access to on-line or video consultation by April 2021

• 100% of Primary Care Networks are using the NWL referral guidance for the agreed specialities by March 2020

• By March 2020 60% of people with SMI have had their five key physical health checks

• From 1st April 2020 100% of Primary Care Networks use the WSIC dashboards regularly to plan care in their network

• By March 2021 75% of people at expected end of life within the following 12 months have a care plan on CMC that is used by the MDT team caring for them

• By April 2021 75% of people with a new diagnosis of cancer will have had their diagnosis by Stage 1 or 2

• By April 2021 95% of children in each PCN will have had their MMR vaccination

We have one

financial strategy

that ensures we use our

resources well

£ PCNs have a plan for engaging

people to use ‘digital first’, engage

with the new roles and get involved

in self care

PCN s will undertake

integrated working

maximising the use of estate

The digital front door is

the way to access urgent

primary care and key

prevention via digital

apps

Each primary care

network has a training

practice that links to the

NWL training hubs

Our staff working together

with other providers to

provide integrated care that

ensures our patients get the

best person to look after

them

A: Our key aspirations to deliver our vision subject to clinical and LMC review

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North West London Model of care delivery (to be signed off by HCP)

North West London Integrated

Care System

General Practice as the foundation of

the wider ICS – working in partnership

with other health and care providers to

collaboratively manage and provide

integrated services to a defined

population with a shared budget

General Practice Based Team

Integrated Care Partnerships

Includes single formal large scale

General Practice organisation E.g.

Federation

Delivering population based

care & population health

management, and large

scale borough wide services

300,000

(circa 8 ICP’s

in NWL)

System

Information

Quality

Improvement

Strategic

Capabilities

Borough

Partnership

Organisational

Capabilities

Public

Engagement

Care Coordination Extended

Access Hubs Rapid

Response

Primary Care Network

Groups of practices and other

community providers

Delivering an integrated

workforce, with a strong

focus on partnerships

spanning all levels of care

30,000-50,000

(53 PCNs in

NWL)

A combined focus on personalisation and quality of care

with improvements in population health outcomes

• Time freed up in General Practice.

• Improved patient experience.

• Improved staff recruitment, retention and morale.

• Time to care – 10 High Impact Changes

• Decrease A&E Attendances and Non-Elective

admissions.

• Deliver NWL Outpatient Programme.

• Improve professional experience/ clinical pathways.

System wide financial

stability, sustainability and

efficiency

NWL Urgent

and Emergency

Care

Other Strategic

Programmes

Strategic

Direction

Public

Communication

Diabetes

Transformation

Digital

Strategy

Estates &

Hubs

Commissioning 2.4 million

Population

Size Responsibility Services / Functions / Programmes

HCP

Governance

01 02 03 04 05 06

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B: Large scale General Practice organisation E.g. Federation and Primary Care Network Development

• Role of

• Voice for Primary Care in their

geographical area in the context

of integrated care partnerships

• Voice at the NWL Health & Care

Partnership Board

• Work with CCGs and LMC to

develop PCN’s / General Practice

• Support Networks, e.g. with back-

office functions

• Develop partnerships - known

partner at HCP level

• Provide services at Borough level

Role of Networks: Operational Delivery Units led by the Clinical

Director

(53 Networks anticipated in NW London)

• GPs working together with local health and care providers, providing

care through multi-disciplinary teams

• Providing care to meet the needs of the whole population.

Accessible care 8am-8pm 7 days per week. Proactive planned care

for high and rising risk patients, coordinated care for complex

patients

• Focus on prevention and personalised care

• Use of data and technology

• Support clinical decision-making, monitor performance and variation

to inform continuous quality improvement

• Use collective resource in the PCN to allow greater resilience,

sustainable workload and access to a MDT skilled and competent

workforce

General Practices – the extended practice team

Coordination and planning of holistic accessible care

8 – 8, 7 days a week

General Practitioners

Working across practices to provide leadership to

a sustainable future model

Patient Groups

Larger role for drive for improved

partnership and personalization

Role of large scale General Practice organisation (8

Federations in NW London) Challenges for Federations:

• No long term funding for the Federations to enable

forward planning as an organisation

Challenges for PCN’s and their Clinical Directors

• Varying levels of maturity and ability to take on new

roles and expectations

• Workforce

• Increasing complexity of patient profiles

PCN Role of Clinical Director:

• Provides strategic and clinical leadership to the PCN

• Influencing, leading and supporting the development

of excellent relationships across the PCN

• Support network implementation of agreed service

changes and pathways with member practices and

the CCG

• Work closely with other PCN Clinical Directors,

Clinical Leaders of Health and social Care providers,

CCG’s and LMC

• Facilitate practices within the PCN to take part in

research

• Represent the PCN at CCG Clinical meetings and

the ICP/ICS

Networks (2019/20)

• Population profile – understanding local needs and demographics, and responding effectively to the likely

increase in patient demand

• Developing relationships across the system with community providers, voluntary sectors, patients, carers and

public

Key set up and infrastructure activities in 19/20

• Agree and define governance and leadership structures

• Network maturity matrix assessment

• Commissioning, contracting, performance management processes established

• Continuous Quality Improvement delivery agreed

• Demand and capacity tools across the networks and workload/workforce planning mobilised

• Professional development and career pathways defined

2020 Goals

• Federation as Mature Organisation supporting

their PCN’s

• Recognised partner with a voice in their ICP

and in the NWL ICS

• Primary Care Networks – Mature Delivery Unit

for delivery of Health and Social Care needs of

the whole population.

NWL HCP, CCGs and the LMC Strategic Leadership Network (SLN) will play a key role supporting the development of Federations and PCN’s to help them to develop the required structure, workforce and capabilities in readiness for the delivery of new services from April 2020 onwards

Network Delivery of 7 Service Specifications

(from 2020)

• Structured Medications Review and

Optimisation (increasing in scope and scale

each year)

• Enhanced Health in Care Homes, to implement

the vanguard models

• Anticipatory Care requirements for high need

patients typically experiencing several long-term

conditions

• Personalised Care

• Supporting Early Cancer Diagnosis

• CVD prevention

• Tackling Neighbourhood inequalities

01 02 03 04 05 06

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V0.11 – 14 May 2019

B: Draft Primary Care Networks across NWL (Final PCN information to be provided on 1 June 2019) The map below represents the spread of Primary Care Networks across North West London.

Harrow (269,533)

• 1 Federation (269,533)

• 3 localities

• Locality 1 (82,874)

• Locality 2 (90,775)

• Locality 3 (92,951)

Central London (231,475)


• 3 Localities under Federation

• Maida Vale and St. John’s Wood (52,257)

• Regents Canal and Paddington (64,578)

• West End and Marylebone (39,984)

• South Westminster Primary Care Home (74,656)

Hammersmith & Fulham (236,604)


• 3 Networks

• Northern (46,534)

• Central (94,356)

• Southern (95,714)

Ealing (440,119)


• 7 Networks

• Acton (77,731)

• Central Ealing (59,605)

• North North (68,229)

• North Southall (74,150)

• South Central Ealing (50,662)

• South North (59,482)

• South Southall (51,824)

Hillingdon (317,044)

• Confederation (309,919)

• 3 Localities

• North (109,232)

• Central (102,916)

• South (97,771)

• 8 Neighbourhoods

• The North – Connect (44,185)

• South Ruislip & Eastcote (35,830)

• Ruislip & Ickenham (32,230)

• Central (TBC)

• Hillingdon & Uxbridge (34,369)

• Yiewsley (36,960)

• North Hayes & Harlington (51,357)

• Hayes Town & Harlington (46,414)

Brent (378,642)


• 3 Networks

• Harness (132,825)

• Kilburn (115,935)

• K&W (129,882)

• 10 Primary Care Homes

• Harness Temple (30,778)

• Harness Stadium (37,565)

• Harness North (34,085)

• Harness Parks (30,397)

• ConnectHealth Alliance (41,300)

• Kilburn Partnership (38,286)

• South (36,349)

• North (45,754)

• Central (41,682)

• West (42,446)

West London (253,424)


• 5 Networks

• Kensington and Chelsea North (40,902)

• Kensington and Chelsea South (59,223)

• NeoHealth (41,591)

• North (55,854)

• South (55,854)

Hounslow (320,632)

• 1 Consortium (320,632)

• 5 Networks

• Brentford & Isleworth (59,394)

• Chiswick (49,435)

• Feltham (70,973)

• Great Western Road (63,881)

• Heart of Hounslow (76,949)

01 02 03 04 05 06

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V0.11 – 14 May 2019

Care Delivery Model

Use dashboards and

benchmarking data to

improve quality,

reduce variation and

deliver evidence

based interventions

Use population health

information to identify

cohorts within PCN

population

Match the skills and

abilities of staff with

interventions,

through training,

development of

competencies and

relationship building

Use the NWL Health

and Care Partnership

outcomes to shape

effective interventions

As we progress with the transformation of Primary Care across North West London, population analysis will be a key enabler across our PCNs, supporting our commitment to providing accessible, proactive, coordinated and preventive care and improving health, wellbeing and independence for all .

Adults with complexity or chronic illness

Children and families

People with mental health difficulties

Frail older people and end of life care

Holistic personalised

care and support

planning for patients

and carers Prevention work and

self management that

helps empower

people and families

and helps support

their physical, social,

mental health and

wellbeing needs

01 02 03 04 05 06

Using digital

technology to make

care more efficient

and more effective for

service users and

professionals

Use the full group of

community, mental

health and voluntary

sector staff working in

the PCN

5/15/2019 12 DRAFT 12

V0.11 – 14 May 2019

Coordinated Care Model for most complex ‘highest risk’ people with frailty and multiple long term conditions

Agreed clinical

improvement model

facilitated by change /

quality managers

Collaboration through

trusting relationships

between everyone to

deliver and plan

coordinated care

Integrated frailty

models between

networks and

secondary care

Consistent clinical

and non clinical care

pathways to reduce

variation

Adults with complexity or chronic illness

Children, young people and families with complex health

needs

People with mental health difficulties

Frail older people and end of life care

MDTs embedded

within PCNs access

to multi-professional

skills addressing

physical, mental and

social needs

MDTs review data in

real-time to intervene

proactively to avoid

deterioration and

admission, and ensure

rapid discharge

01 02 03 04 05 06

Using digital

technology / IT

systems to enable

sharing of information

between

organisations and

transfer of care

Use of NWL

population risk

stratification to

identify high risk

patients

Collaboration

between MDTs to

deliver planned

coordinated care with

proactive coaching to

support PAM and self

management

Rapid access home

care (including care

home residents)

provided by MDTs

Partnerships working

with voluntary sector,

social prescribing link

workers, public,

patients and carers

5/15/2019 13

DRAFT

Primary Care Strategy Delivery Roadmap

5/15/2019 14 DRAFT 14

V0.11 – 14 May 2019

Primary Care Maturity Journey

01 02 03 04 05 06

The following slide shows our draft roadmap with the expected milestones to develop local Primary Care, in line with national ambitions.

Complete baseline maturity assessment Develop aligned funding plan Develop detailed plans by PCN

• Undertake a comprehensive PCN

Maturity Assessment to understand

existing strengths and development

requirements across NWL using

national template

• Use this base lining work to support

assessment and identification of areas

of greatest priority for investment

• Define deliverables across all HCP

Strategic Initiatives and enabling

programmes to ensure steady progress

for every area, with particular emphasis

on reducing unwarranted variation and

reducing inequalities, and improving

QOF

• Map the development of training hubs

across NWL

• Baseline assessment of HCP priorities

and PCN priorities are informed by

assessment of local landscape in each

PCN which will inform funding plan and

use of OD (GP at scale) money.

• This is to completed and mapped to

PCN Maturity Assessment work to

develop spending and implementation

plans through to 2023.

• Funding focus on building an

organisational, clinical and business

model in each PCN that supports

sustainability and resilience

• Detailed delivery plans to be developed

across each PCN, based on population

health information, WSIC dashboards

and GP data packs

• Finalise the roles and responsibilities of

the Clinical Director, and support

Networks in securing nominations and

necessary development (including OD)

• Practices to identify local PCN partners

and develop shared plans for service

delivery.

• Patient and public voice plan for each

PCN, including use of digital technology

that includes equitable and access to

care, and plans for social prescribing

and care navigation

• Workforce plan to be developed for

each PCN that links into training hubs

5/15/2019 15 DRAFT 15

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Developing Primary Care Network Roadmap

FY19/20 FY20/21 FY21/22

Rela

tionship

Develo

pm

ent

Digital Estates & Hubs Workforce Planning

Continuous

Qualit

y

Impro

vem

ent

Popula

tion

Health

Managem

ent

Public

& P

atient

Engagem

ent

Leaders

hip

&

Work

forc

e

Contracting & Commissioning

Current State

Target Model

GPs, Primary Care

leadership and other

stakeholders believe in the

vision & plan to get there

Practices identify PCN partners

and develop shared plan

Integrated teams, which may

not yet include social care and

voluntary sector, are working in

parts of the system.

Early elements of new models of care in place for most

population segments, linked to HCP priorities. integrated

teams throughout system, including social care, the

voluntary sector and easy access to secondary care

expertise. Routine peer review. - linked to model of care

on slide 8

New models of care in place for all

population segments across system.

Evaluation of impact of early-

implementers used to guide roll-out

General Practice has the

headroom to make change Analysis on variation in

outcomes and resource

between practices available &

acted upon

Networks have sight of

resource use and impact

on system performance,

and can pilot new incentive

schemes. Steps taken to ensure

operational efficiency of

primary care delivery and

support struggling practices.

PCNs take collective responsibility

for available funding. Data being

used in clinical interactions to make

best use of resources.

Basic population

segmentation is in place,

with understanding of

needs of key groups and

their resource use

Standardised end state

models of care defined for

all population groups, with

clear gap analysis to

achieve them.

Systematic population

health analysis allowing

PCNs to understand in

depth their populations’

needs and design

interventions to meet them

National Investment

Locked In

Evolution Document

Finalised``

Non recurrent GP @ Scale Forward

View Funding

People available with right

skills to support change

Plan in place with clear vision

and steps to get there at

network, place & system level;

investment plan linked to HCP

and network priorities

Primary care has a seat at

the table for system

strategic decision-making.

Functioning interoperability

within networks, including

read/write access to records,

sharing of some staff and

estate

PCNs have defined future

business model and early

components in place

IT-enabled access to

shared protocols, and real-

time information on patient

interactions with the

system

Primary care plays an

active role in system

tactical and operational

decision-making, for

example on UEC

PCN business

model fully

operational

Fully interoperable IT,

workforce and estates

across networks, with

sharing between networks

as needed

Primary care providers full

decision making member

of ICS leadership, working

in tandem with other

partners to allocate

resources and deliver care.

Workforce plan in place for

each PCN that reflects

workforce trajectories

01 02 03 04 05 06

Engage with PPGs where

they are in place and

create PCN public and

patient engagement

network in PCN

Training practice in place

in each PCN that links to

the training hubs and up-

skilling programmes

reflected in workforce plan

Maturity matrix carried out in

each PCN and OD funding set

against PCN priorities for

development and linked to

HCP prioriteis

Baseline assessment in

each network includes

demographics, patient

outcomes, practice

variation and population

health needs - network

priorities workforce and

investment plan updated

accordingly

5/15/2019 16

DRAFT

Primary Care Strategy Delivery Structures

5/15/2019 17 DRAFT 17

V0.11 – 14 May 2019

Programme structure & inter-relationships

North West London Wide Support

Health & Care Partnership

Dig

ita

l

Esta

tes &

Hu

bs

Wo

rkfo

rce

Pla

nn

ing

Pu

blic

& S

take

ho

lde

r E

ng

ag

em

en

t

Federation/ CCG Support

Primary Care Networks

Outpatients

Same Day Emergency

Care

Non-Elective Demand &

Flow

Staff Wellbeing

Chronic Disease

Management

Healthy Communities

Population

Health

Management

Workforce

Planning

Relationship

Development

Contracting &

Commissioning

Cross Cutting Enabler Programmes Other HCP Programmes

Delivery of this model will require support by each of the HCP programmes and enablers at all levels, NWL-wide, at CCGs and Federations, and within the Primary Care Networks themselves to support the achievement of our stated ambitions.

Continuous

Quality

Improvement

Leadership &

Workforce

01 02 03 04 05 06

5/15/2019 18 DRAFT 18

V0.11 – 14 May 2019

Governance

Responsibility for defining and approving the overall

strategy.

Endorsement of PC programmes and PC

spending plans across the system, providing overview

and assurance on the delivery of the strategy

Responsibilities TBC

Sign-off and delivery responsibility of the PCN

Plans and aligned Primary Care Strategy.

Regular reporting to CCG Governing Bodies

Strategy & Transformation –

Primary Care Leads


Team

Responsibilities TBC

NW London Health & Care Partnership Board

Chair: Lesley Watts

Primary Care Board

To be agreed if we need one

Social & Community Board

To be agreed if we need one

NWL Primary Care Commissioning Committees

NH

S B

ren

t P

CC

C

NH

S C

en

tral

Lo

nd

on

PC

CC

NH

S E

alin

g

PC

CC

NH

S

Ham

mers

mit

h &

F

ulh

am

PC

CC

NH

S H

arr

ow

P

CC

C

NH

S H

illin

gd

on

P

CC

C

NH

S H

ou

nslo

w

PC

CC

NH

S W

est

Lo

nd

on

PC

CC

Enhanced Service

Contracting

Under the leadership of the NWL HCP Board a new governance structure is being implemented to manage these inter-related programmes of work and support the development of Primary Care Networks across the CCGs.

Primary Care Virtual Team

Primary, Social & Community Care Board

Chair: Andrew Ridley

1

2

3

4

5

1

2

3 4

5

8 x CCG Primary Care Leads and Teams – will need to be updated as appropriate to reflect a single CCG within the relevant timescale

Programme Management Function

Primary Care Finance & Operations

Group

01 02 03 04 05 06

5/15/2019 19

DRAFT

Primary Care Strategy CCG Achievements To Date

5/15/2019 20 DRAFT 20

V0.11 – 14 May 2019

Snapshot of local progress

Example

NHS Brent CCG

• During 2018/19 the primary care networks were formalised across Brent, practices are aligned to 10 Primary Care Networks with 4 in Harness Locality, 4 in

Kingsbury and Willesden Locality and 2 in Kilburn Locality.

• PCNs have engaged with member practices and wider stakeholders and identified a series of clinical priority areas of focus and is currently developing

pathways and collaborative ways of working, with the aim to start delivering community services in the near future.

• The PCN leads meet with the CCG on a regular basis to further develop PCNs and are increasingly working collaboratively

• The Brent Integrated Care Partnership Board was set up in October 2018, to drive delivery of integrated care. There is a strong focus on the programme being

primary care led, all key stakeholders are represented on the Board with representation from primary and secondary care, Brent Local Authority, the Voluntary

Sector and patient representatives.

• A Brent ICP model of care has been developed to deliver proactive care to the rising risk population within the community at a PCN level in order to reduce

unnecessary admissions / A&E attendances. The PCNs will proactively manage these cohort of patients via an enhanced MDT using a population health

management tool. PCNs will work with community and voluntary teams to reduce unplanned care by proactively managing these patients within the community,

encouraging self-care and ensuring better outcomes for patients.

• An integrated models of care delivery group has been established to support implementation, agree new ways of working and to test how the model of care can

work in practice. There is a strong focus on population health management with a shift from activity and processes to improving quality and health outcomes

which aligns closely with the ambitions of the ICP. The delivery group has representation from all key stakeholders.

• The Harness PCNs will begin delivery of the proposed model of care in May 2019 with the K&W PCNs following in August and the Kilburn PCNs in November.

The enhanced MDT have met in shadow form to agree new ways of working in order to better to manage the identified cohort of patients.

• The MDT will continue to meet in shadow form until the end of April to refine the model and develop collaborative working and have agreed a launch date of 1

May 2019.

NHS Central London

CCG

• Lead providers for our at-scale contract have mapped staffing within their networks and have understanding of the level of resource in the system. Sharing

of staff across the network is increasing. They also have training records and competencies required. Next steps will be to model the future workforce.

requirements against demand and capacity audits and develop plans for the use of additional roles and maximising skill mixes within networks

• Working as part of networks using peer support has driven up the quality for diabetes patients

• Plans are well underway for the integrated community team pilot and will include those patients with rising risk of complexity in their health conditions. The

project group has developed the metrics and outcomes that will measure the success of the pilot and these have been built into the spec. An MoU between

providers is in development .

• Online consultations pilot is now fully underway. The service has been extremely popular amongst the student population with early indications of high

patient satisfaction with the service.

• Networks are working collaboratively with shared governance arrangements and committee/board meetings that consider both quality and performance.

There is also a provider board covering all networks and lead providers of the at-scale contract have used this forum to collaborate and deliver the

community cardiology service which will commence in May 2019

01 02 03 04 05 06

During 18/19, using the Next Steps Strategic Commissioning Framework, we have made good progress, working with our GP Federations and our developing networks, to put the building blocks in place towards delivery of our vision. This includes creating a wide population health algorithm to identify “rising risk” cohorts of patients, piloting network-based online consultations and contracting at scale with our Federations and networks. The following are examples of CCG progress against the Strategic Commissioning Framework:

5/15/2019 21 DRAFT 21

V0.11 – 14 May 2019

Example

NHS Ealing CCG

• Practices signed an MoU with Ealing GP Federation giving the latter the mandate to act on their behalf

• Discussions around the contour and sizes of PCNs well underway and are highly likely to reconfigure existing networks in Ealing

• Different networks making progress at different rates – some are defining functions of the network where some are in the process of selecting the Clinical

Directors

• Ealing GP Fed providing the administrative support for the discussions

• CCG monitoring the progress and possible impact on patient care without interfering

• The provider of the platform for the preferred Online consultation module selected

• Digital Appraisal group membership being extended to include commissioners and become digital steering group

• Staff Bank provider selected and now moving to mobilisation

• Weekly meetings between Fed and CCG in place to monitor progress.

NHS Hammersmith and

Fulham CCG

• GP at Scale Development plans for each network submitted, reviewed and approved by the CCG and MOUs signed

• Networks all received GRASP COPD training to improve capability and identify needs for undiagnosed COPD to support population health management.

• Developing Network Collaboration and Culture

• Initiated a series of away days to develop shared values between practices and clarify the vision for the network. The away days act as a platform to

develop trust between the practices and support the formation of a shared identity across the network.

• Undertaken a SWOT analysis to further develop plans for network delivery.

• Started a process to review how to distribute payments for population health management contract to support individual practice improvements aligned to

network benefits and maximising inter-practice and developing reciprocal relationships.

• Supporting the development of staff to make better use of workforce resources and to foster distributive leadership .

• Funding three practice managers to undertake the NAPC Advance Diploma in Primary Care Management

• Developing practice teams through participation in the Going for Gold programme

• Developing an asset based approach in recognition of the high degree of social need within the network demography which is insufficiently served by a

medical model.

• Progress to date has focused on introducing a network level PPG and working with White City Community Enterprise on social prescribing.

• Scheduled biannual educational events based on network clinical priorities (Mental Health and Frailty) with specialist consultants attending as external

speakers

• Initial conversations started to identify requirements for a shared services function working across the network to ensure patients received the correct

treatments and medication at the right time. The shared function will also share best practice across the network.

• Identifying staff to receive training for care navigation and sign posting to support efficient workflow and improve the front of house experience for patients.

• The Network have recruited a data analyst to work with practices to help streamline processes and improve workload management through collaboration.

• Collectively the network will use the data to understand the opportunities related to collective assets and pooling resources

• The network are arranging network wide PPG meeting to explore Population Health Management educational sessions including discussion of Patient

Activation and linking with third sector organisations.

• The network have undertaken a training needs analysis and are organising sessions to provide staff with violence and aggression training and care

navigation.

Snapshot of local progress The following are examples of CCG progress against the Strategic Commissioning Framework:

01 02 03 04 05 06

5/15/2019 22 DRAFT 22

V0.11 – 14 May 2019

Example

NHS Harrow CCG

• Harrow currently has adopted a phased and robust gateway approach in releasing investment within the ‘at scale’ development programme. It is therefore

advantageous to build on this approach to invest the additional support into Locality Development (via HHL CIC). To date, HHL CIC has made steady and

positive progress within the existing Gateway Delivery Process and have formed effective working relationships with the emerging 3 Localities.

• The CCG have agreed (from April 2019) to commission a range of enhanced services, which will be commissioned at a locality, rather than Practice, as set

out in our Primary Care Strategy, to ensure 100% population coverage. Both the budgets and activity will be set at a locality level from April 2019. Moreover,

the CCG is currently in the process of developing a business case to progress an out of hospital contract, which will look to commission a wider range of

enhanced services at locality level (from July 2019).

• It is essential to mobilise the Locality based providers within a timely manner and ensure readiness in preparation for April 2019, through an adequate

package of financial support and diagnostic assistance. The CCG thus proposed to utilise this investment to deliver its key strategic priority of ‘at scale’

working within Harrow via an additional gateway; focusing on acceleration, provider readiness and mobilisation to deliver a range of healthcare services

from 1st April 2019 and beyond.

• This approach was approved by the CCG’s PCCC in February 2019.

NHS Hillingdon CCG

• Established 8 live neighbourhoods

• 6 Neighbourhood Co-production Events – between November and March which had representation from practices, CNWL community & MH, THH acute and

3rd sector representatives

• Population Health Analysis & Patient Research – ‘snapshot’ population health analysis completed for 8 neighbourhoods – with additional co-research of 20

patients and 20 staff across the borough and partner organisations to formalise neighbourhood priorities to inform 19/20 plans

• Hillingdon Primary Care Dashboard – completed 2nd release of dashboard and training to practices and neighbourhood staff – including an Early Warning

System (unplanned care) – now embedded NWL BI Solution Early Adopter (x3) – Launched Learning Lab approach for 3 neighbourhoods which includes 1)

reduction of unplanned care, 2) neighbourhood virtual and shared resource allocation and EMIS Hub, 3) Remote patient tele-monitoring. Evaluation and

outputs completed

• Leadership, OD & Behavioural Change – developed integrated management structure for neighbourhoods, leadership development framework and

OD/Coaching support for all 8 neighbourhoods – linking in PCN establishment

• Proactive Care – further development of Care Connect Teams – move from 65+ to 18+ model and further mobilised for 8 neighbourhoods

• ‘Wrap Around Service’ – current ‘as-is’ mapping of primary, community, mental health, 3rd sector and acute workforce against neighbourhoods.

Neighbourhood mobilisation plans are finalised for 19/20 deployment

• Digital – pragmatic short-term technical solution has been developed to enabled MDT staff working across primary care, community, MH and 3rd sector

partners to support case management and integration of tasks and activities

• Backfill – established backfill funding for GPs and practice managers to be part co-production activities and Early Adopters


01 02 03 04 05 06

5/15/2019 23 DRAFT 23

V0.11 – 14 May 2019

Example

NHS Hounslow CCG

• GP consortium maturity developed through increased operational support.

• •Allied Healthcare programme in place to improved access and address locality inequalities and reduce variability of service delivery across Hounslow

• •Joint at scale programme with HRCH

• •CEPN Nurse and Mentor programme developed

• •Consortium as a key local partner to integrated care and involved in the development of the full business case for integration in Hounslow

• •Joint outcomes in place across community and primary care contracts

• •Joint working is supported through the delivery of the Enhance Primary Care Contract which includes network based performance targets as well as a gain

share around a reduction of Non-Elective Activity

• •Directors in post representing all localities with an MOU for joint working in place across the five

• •Formal agreement in place with community trust for the delivery of staff included Allied Health Professionals such as pharmacists, physicians associates ,

physiotherapists and paramedics

NHS West London CCG

• Engagement begun on potential changes required in line with national guidance

• Agreement to re-align CLS meetings in-line with PCNs for 19/20

• Stage 2 Plans finalised across all PCNs with focus on delivery

• Monthly PCN Development Forum has continued to discuss a range of topics

• Focus on development of Integrated Community Teams that interface with PCNs

• Local Objective Plans implemented across Networks on a range of areas

• SystmOne support required, where applicable to operationalise across Networks

• Links established with Voluntary Sector seeking to understand resources available

• GP Federation representation within Alliance Leadership Group

• GP Federation taking lead role on alliance Workstream for single management structure

• GP Federation providing bespoke support across all PCN

• GP Federation purchase of SystmOne commissioner module

• GP Federation established as holding funding on behalf of 4/5 PCNs


01 02 03 04 05 06

5/15/2019 24

DRAFT

Primary Care Strategy What we need to do to achieve our vision

5/15/2019 25 DRAFT 25

V0.11 – 14 May 2019

A: Overview A number of strategic initiatives and cross cutting enablers have been identified to enable delivery of this Strategy

01 02 03 04 05 06

Responsibility

Federation & Network Development

Population Health Management


Public & Stakeholder Engagement

Integrated Care Partnerships

Digital

Estates & Hubs

Workforce Planning

North West London Health & Care Partnership

(Integrated Care System)

A

B

C

D

E

F

G

5/15/2019 26 DRAFT 26

V0.11 – 14 May 2019

C: Our Quality & Safety Standards

Accountability across our Health & Care Partnership Our ambitions in practice

• Focus – our seven inter-connecting programme areas for the Health & Care

Partnership

• Evidence – collecting and monitoring the data for our outcomes and quality

standards

• Local Delivery – Primary Care Networks, supported by a Clinical Director

with a focus on quality, able to access integrated teams of community and

mental health support, taking a population health approach and informed by

the borough’s Joint Strategic Needs Assessment (JSNA)

• Social, community and voluntary support – integrated teams of

professional (and voluntary) support for children and families, people with

disabilities, frail older people, and their carers

• Urgent & Emergency Care – a fast and responsive service by NHS 111,

999 and London Ambulance Service, and backed up by face to face

treatment or advice by the right professional

• Specialist Care – Clinical Networks, serving local populations of 500,000 to

1 million

• Buildings and Equipment – investing in the capital support that

professionals need, so that users of all services can be seen in the right

place, by the best specialists, with the right resources and training

• Recruitment, Retention, Training and Research – attracting the best

professionals to work in NW London, and offering them a rewarding and

inspiring place to develop their careers

• Sustainability – through sharing resources across boundaries, the

organisations in our Partnership can plan development of care on solid

foundations, rather than the stop-go basis of recent years. Taking as our

resource the single financial envelope across our NW London Partnership,

and working differently across our boundaries, we aim to deliver the best

outcomes we can within the resources we have at our command.

01 02 03 04 05 06

Quality Dashboard

A Primary Care Quality Dashboard was approved by all CCG primary care

committees by March 2019. The dashboard summarises key information that is

either available in the public domain or available from NHS England returns from

primary care and is intended to give an overview of GP primary care quality through

the available information which acts as a benchmarking tool.

It is intended that the information will enable the primary care committees to focus on

and prioritise key concerns to support quality improvements in general practice.

It is recognised that there is some overlap between the criteria used for the quality

dashboard and performance assurance therefore the quality and primary care teams

will work together to prevent duplication and minimise repetition.

Quality leads already participate in and lead assurance monitoring visits to GP

practices however this tool will enable prioritisation of support and proactive

scheduling of practice visits.

Patient Safety

December 2018 ‘Reporting and Management of Incidents and Serious Incidents in

Primary Medical Services - A Working Guide for CCGs’ published by NHSE. This

has been circulated to CCG Governing Bodies for noting and will be followed up with

bespoke local guidance and support to individual practices as required.

CQC inspection

To continue to work with and support quality improvement in primary care to align

with NWL strategic quality objective to move all providers from current CQC ratings

to good or better.

Time to care

April 2016 - General Practice Forward View highlighted the importance of releasing

time to care. National Resources have been identified to support groups of practices

on their own Time to Care programmes.

5/15/2019 27 DRAFT 27

V0.11 – 14 May 2019

D: Population Health Management (Adults over 18 years) Population Health Management is a proactive approach to managing the health and well being of a population. It incorporates the total care needs, manages cost and demands, and plans improved outcomes for the population. By segmenting the population into groups of people with similar needs, tailored and targeted interventions can be designed for both these population cohorts and the individual citizen within.

Core general practice.

Coordination and planning of

holistic accessible care 8 – 8

7 days a week.

Networks /Primary Care

Home teams of practices –

assess population needs

and design integrated care

services.

Multidisciplinary Workforce

arranged in teams with case

management across health

and social care.

Most

complex

Rising risk

Moderately

Complex

Stable risk

Well 75-80%

of patients

2-3%

of patients

15-20%

of patients ‘Rising risk’

‘Highest risk’

‘Well’

Patients Setting Risk

01 02 03 04 05 06

5/15/2019 28 DRAFT 28

V0.11 – 14 May 2019

D: Population Health Management (Adults over 18 years)

Specialist/ End of Life

Patients already likely to be

receiving End of Life or

Specialist Services and

therefore probably not

appropriate for case

management or care

planning

Any of the following:

• On Palliative Register

• Renal dialysis/ Chronic

Kidney Disease Level 5

patient

• Cancer treatment (last 18

months)

• Known to Community

Matron (last 6 months)

• Living in Residential/

Nursing home (aged 65+)

0.7% of total adult population

High Risk

Very complex patients with

comorbidities and/or high

admission risk who may

benefit from case

management to co-ordinate

their care more effectively

Not in Specialist/ End of

Life group, but with any of

the following:

• Severe eFI

• 2% most likely to be

admitted (QAdmissions)

• 4+ Non-elective

admissions (last 12 months)

• Known to District Nursing (last 6 months)

• Housebound and

receiving community

services

2.9% of total adult population

Rising Risk

Patients with existing

conditions who are also

outliers for service use or

control of their health. May

be suitable for proactive

care at Network or Practice

level

- Not in Specialist/ End of

Life or High Risk groups

- Meeting the

requirements for

inclusion into the

Stable Risk group

- But flagged in two or

more of the following

‘Rising Risk’ categories:

• 3+ A&E attendances

(last 6 months)

• 100+ GP events (last 6

months)

• 3+ DNAs (GP, Outpatient,

Community in last 6 months)

• Failing Key clinical

‘markers’ (Heart Failure,

COPD, Hypertension,

Asthma, Diabetes, SMI)

• In an at-risk category (e.g.

Dementia, falls risk, new LTC

diagnosis, recent bereavement,

75+ and carer,75+ and living

alone, PAM low engagement)

0.6 % of total adult population

Stable Risk

Patients with existing

conditions who are NOT

outliers for service use or

control of their health.

Likely to be suitable for

routine LTC management at

Practice level (e.g. QOF)

- Not in Specialist/ End of

Life, High Risk, or

Rising Risk groups

- Meeting the

requirements for

inclusion into the

Stable Risk group – any

of the following:

• Moderate eFI

• On 1+ QOF disease

registers (Exceptions: obesity,

smoking, hypertension,

hypothyroidism, asthma non-

inhaler, depression)

• Non-Diabetic

Hyperglycaemia or CVD

risk (QRisk 20+)

• Substance misuse/

alcohol dependence

• Morbid obesity (BMI 40+)

• 20% most likely to be

admitted (QAdmissions)

19% of total adult population

Well

Patients with no long-term

conditions or risks who

may be most suited to

transactional care (e.g.

routine appointments)

- Not in any of the other

Risk groups

77% of total adult population

01 02 03 04 05 06

5/15/2019 29 DRAFT 29

V0.11 – 14 May 2019

Opportunity for funding could be

released from Out of Hospital

Enhanced Services to

commission from PCNs across

the ICS, strategic delivery

programmes, that primary care

can contribute to delivery

E: Contracting & Commissioning

To develop and fully mobilise the PCNs there are a number of contractual levers that will need to be aligned to the new commissioning model. Further analysis is required to ensure efficiency and realise any opportunities for funding reallocations.

NWL ICS transformation programmes

Out of Hospital Enhanced Services

Primary Care Network DES

Analysis required to understand what can

be streamlined by each CCG to avoid

duplication between the PCN DES and

the Out of Hospital Enhanced Services.

Contract designed to support

practices to develop and implement

PCNs, working in conjunction with

neighbouring practices within their

area, to deliver seven PCN service

specifications

Range of enhanced services currently

delivered across CCG footprints need to

be reviewed in the light of the Primary

Care Network DES and value for money.

01 02 03 04 05 06

PCNs have a key role in contributing

to the delivery of the ICS

transformation programmes and the

system recovery plan

5/15/2019 30 DRAFT 30

V0.11 – 14 May 2019

E: Commissioning and Contracting

Core principles underlining commissioning and contracting

Key area of focus going forward

Aspirations

Network Plan Review Domains to include : • ’

01 02 03 04 05 06

• To deliver whole population coverage of services with clear outcome for patients

• Commissioning intentions are evidence based

• To deliver high quality service provision through consistent and well-developed

principles to contract management and sub-contracting (where applicable)

• Consistent approach to development of the workforce, the inclusion of robust guidance

in training and competency requirements within service specifications and

commissioning of training through training hubs

• Commitment to a consistent approach to pricing and costing of services ensuring that

the same price is set out across NWL for the same services (where applicable)

• Contracting mechanism to be flexible to wider collaborations and partnerships with other

type of providers as the system moves to integrated care contracting

• Continuous patient engagement in the development and monitoring of services

• Adopt consistent outcome based commissioning approach to contracting for services

that is in line with the agreed outcomes for NWL for integrated care commissioning

• Patient safety, health outcomes, patient experience, reducing health inequalities ad

safeguarding all remain central to delivery of high quality, personalised service provision

• Quality and Safety – performance against a set of key indicators relevant to that Network

• Evidence of outcome for patients

• Financial stability

• Performance – performance against a set of targets relevant to that Network Plan

• Evidence of user and stakeholder feedback

• Consideration of any contractual incentives in the context of financial recovery, investment

and incentive risk share/gain share

• Contribution to system financial recovery

• Use contracting mechanism and levers to reduce variation within primary care

• Support single contracting mechanism for DES Network contract and Enhanced Services

provision

• Use of dashboards and analytics to monitor performance of Network Plan

• Transition current ‘wrap around’ contract into appropriate delivery mechanism for

Enhanced services (Networks, Federations etc.)

• Ensure all patients have equity of access to commissioned services through robust

contract monitoring

• Be open and honest in discussions, in particular where Networks are not achieving and be

open about adopting a collaborative approach to emerging difficulties

• Test/validate contracting approach with network plan providers

• PCNs as building blocks to an Integrated Care System

• Contracts delivered through wider population based contracts at Network level rather than

at individual practice based level

• Meet with holders of the Network Plan on a regular basis to discuss all monitoring,

reporting and target requirements

• For Enhanced Services, the CCG will operate within the contractual levers and incentives

available to it

• Meet with holders of Network Plans to discuss long-term strategy, critical issues, areas for

provider improvement and how each party can contribute to improving the relationship

• Networks and Federations will be encouraged to have a quality improvement programme

in place that peer learning across practices will improve the quality of services and reduce

unwarranted variation

5/15/2019 31 DRAFT 31

V0.11 – 14 May 2019

F: Digital

• All practices have up-to-date and informative online presence by April 2020

• Implement the next version of the GP IT Operating Model, starting in 2019/20; and GP IT Futures (replacing GPSoC) from Dec 2019

• All GP practices enabled to provide functionality offered through the NHS App to 100% of the population; online access to the full record from April 2020; electronic prescriptions as a default from April 2019; at least 25% of appointments available for online booking by 31 July 2019;

• 100% 111 direct booking into extended access services. Increasing percentage of appropriate patients triaged by NHS111 receiving a face-to-face appointment to greater than 40% by 31 March 2020

• NHS to offer a ‘digital first’ option: 75% of practices to offer online consultations to their patients by March 2020 (Annex F of Planning and Contracting Guidance); all patients having the right to digital-first primary care, including web and video consultations by April 2021 (per GP Contract), every patient in England able to access ‘digital first’ primary care by 2023/24 (per Long Term Plan)

National Digital Transformation Requirements North West London Digital Aspirations

• Better communications with other providers, sharing information and joint access to records

• A clear and locally responsive Primary Care Digital Strategy, reflecting the changes underway to the GP and Primary Care Network contracts

• Digitally enabling Primary Care Networks with infrastructure and clinical systems, equipping them to develop their own ‘digital first’ offer run by our own clinicians, building on NW London’s Digital Accelerator for e-Consultations

• Clinical lead(s) to drive local business change in general practice and urgent care, including support system-wide local adoption, secure CCG engagement and assure clinical readiness and safety before solution deployment

• Increased user engagement and communications, resulting in increased user experience and uptake when live; digital transformation is not just about IT systems, it requires a programme of change to processes and culture

• Explore common ground with ‘bricks-and-mortar’ premises to deliver seamless digital and face-to-face care

• NW London has made considerable progress towards its digital strategy goals within primary care: interconnected shared records to support GP Federations and joint working with community services; enabling the Whole Systems Integrated Care (WSIC) dashboard.

• Initiation of the e-Consultations Digital Accelerator, piloting by Harness and Kilburn Networks (Brent CCG) of an e-Hub (e-Consult at scale) to enable clinicians to review online queries from patients in 28 practices (190K population), to common standards, reducing pressure on practices; South Westminster Primary Care Home (Central London CCG) using Engage Consult in individual practices.

• Roll out of the locality-based health and care navigation app, Health Help Now, to 90,000 patients across multiple CCGs – this signposting app supports easy equitable access to clinical and non-clinical care and support

Our Digital Transformation journey so far Key areas of focus going forwards

• Build on NW London’s e-Consultations Digital Accelerator – enabling online triage, booking and conducting digital consultations - deploy across CCGs

• Link primary care to a longitudinal integrated digital record across health and social care (Health and Care Information Exchange) –to support transformation of Out of Hospital care and virtual Outpatients, making GP data available in other settings

• Design an exemplar digital practice and Urgent Treatment Centre

• Develop a shared App Strategy to help people manage their own well-being, health and care, with common links to the NHS App as ‘digital front door’ to Health Help Now and other apps supporting service users

• Identify funding for investment in infrastructure and shared clinical systems

• Build on our strong record on Information Governance across health and social care, to protect patient and carer data

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G: Estates & Hubs

• Providers coming together in a primary care network will assess their

existing estate, considering how to make best use of their collective estate to

deliver their chosen care model appropriately and to its full capacity

• Through working more collaboratively, providers will be able to agree how to

use their premises differently across the Network

• Providers to review how estates can be tailored to meet the increasing

emphasis on delivery of out of hospital services and facilitation of hub or

network working

• Systems to detail robust, affordable local estates strategies, including

surplus land disposal ambitions across the ICS

• Providers to comment on delivery of energy efficiency, clinical space

utilisation in hospitals and modern operating models for community services.

National Estates & Hub Requirements North West London Estates & Hub Aspirations

• Development and implementation of a hub and spoke model to streamline

shared estate use, and bring together Primary Care at Scale, the model of

care in primary care networks and out of hospital working into primary care

settings

• Improve primary care premises to better meet Health Building Notes (HBN)

standards, Disability Discrimination Act (DDA) compliance requirements and

Care Quality Commission (CQC) standards.

• NW London is currently undertaking a stocktake of primary care estate

across all CCGs. This review is looking to identify:

• The ongoing needs for primary and community hubs within the

area

• The financial challenge, both capital and ongoing revenue

• The model of care in Primary Care Networks supported by primary

and community estate

The results of this stocktake will be reviewed and shared with Primary

Care Networks as part of their Maturity Assessment Framework

Our Estates & Hub journey so far Key areas of focus going forwards

• Map the Primary Care estate to understand the system-wide One Public

Estate position, including the deterioration of PC estate and the capacity of

the estate in areas with significant residential and housing growth.

• Scope and cost the organisational development required for Primary Care

Networks to achieve new ways of working, delivering the new model of care

• Explore common ground with digital innovation work to deliver seamless

digital and face-to-face care

• The impact of technology on the effective use of primary care estate, and

estate requirements

• To map the workforce trajectories against space available in estate

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33

Our Primary Care Workforce Plans builds on a well established NW London Primary Care Workforce Strategy. The plans aim to set a consistent

approach to primary care workforce transformation over the next five years; acknowledging and building on existing work and investment, local

recruitment and retention challenges for GPs and general practice nurses, and opportunities such as the Primary Care Network (PCN) Contract. PCNs

provide greater opportunities for portfolio roles, career development and expansion of the skill-mix in primary care. Delivering such change at scale

and pace requires strong leadership and wide scale culture change in the way primary care organisations are led, managed, and how staff are

rewarded. Our plans are central to achieving the ambitions of the NHS Long-Term Plan to support the development of an expanded primary care

workforce and multidisciplinary teams.

Recruitment & retention remains one of our biggest challenges despite the significant programmes of work delivered so far, with both GP and general

practice nurse numbers continuing to fall. This is compounded by high vacancy rates in other areas of the sector and a high local retirement

demographic amongst both groups.

We recognise the scale of this challenge and are committed to reversing the decline by enabling NW London to become one of the best places in

England to develop a career in primary care. To do this, we need robust and ambitious workforce plans, which;

Improve the profile of primary care in NW London

Significantly improve recruitment of trainees into primary care on qualifying

Create flexible, portable and attractive career opportunities, including portfolio careers

Promote standardised T&Cs

Invest in the wider primary care workforce

Upscale successful initiatives to maximise impact

Drive forward the development of PCNs and Community & Primary Care Training Hubs

Our plans capture the programmes scheduled for 2019/20 and aspirations for 2020-24. Plans for year two - five will be further developed in

collaboration with stakeholders to ensure they are comprehensive, robust and meet the aspirations laid out in the strategy.

Our plans are based on the following themes, all of which are underpinned by the need for systems leadership and sharing best practice;

H: Workforce Planning: Our vision is to become one of the best places in England to develop a career in primary care

Recruitment Retention Portability Productivity OD

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H: Workforce Planning

National Workforce Requirements Workforce Aspirations

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• Create a modern employment culture, with improved morale,

health and well-being and supported by a common T&Cs

framework; enabling NW London to be seen as an excellent

place to develop a career in primary care.

• Maximise recruitment into primary care, and create flexible,

rewarding and attractive career opportunities to reverse the

downward trajectories for GPs and general practice nurses

• Support the development of an expanded, primary care

workforce which makes best use of the multi-professional skill-

mix and supports productivity

• Recruit to a wider range of new roles, including; Clinical

Pharmacists, Physician Associates, Social Prescribing Link

workers, First Contact Physiotherapists and Advanced Clinical

Practitioner Paramedics.

• Harness opportunities for career progression and portability of

qualifications for clinical and non-clinical staff across the health

and social care landscape

• Every primary care network has a training practice that links to

a well-established Community and Primary Care Training Hub

• Facilitate innovation, integration and partnership working

across the Integrated Care System

• Workforce plans should take into account local multi-disciplinary

workforce needs, working with PCNs to recruit an expanded range

of clinicians and other professionals, including plans to retain as

many GP trainees as possible

• Newly qualified doctors and nurses entering general practice will be

offered two year fellowships

• Systems to be in place to offer full time employment to locally

trained student nurses on qualifying, with providers collaborating to

ensure 100% of qualified nurses are able to find NHS employment

where they wish to work

• Plans should include a focus on health and well-being of the

workforce

• The national GP Retention Scheme should be offered to support all

eligible GPs who cannot work a regular part-time position, to

remain in practice.

• Delivery of the GP nursing plan to support nurses to choose

primary care as a first destination and retain experienced nurses

already working in primary care.

• All staff in primary care settings to have access to the support of a

training hub and capacity to participate in training programmes

• Clinical pharmacists are recruited into practices in line with

approved applications for the clinical pharmacist programme

• Work with HEE to ensure robust training programmes are in place

to adequately support workforce plans

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H: Workforce Planning

Our Workforce journey so far Key areas of focus going forward

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• Reverse the downward trajectory for GPs and general practice

nurses, by offering a structured retention package for primary care,

increased recruitment of International GPs, GP Trainees and newly

qualified nurses

• Recruit, retain & integrate a wider range of new roles; Clinical

Pharmacists, Physician Associates, Social Prescribing Link workers,

First Contact Physiotherapists and Advanced Clinical Practitioner

Paramedics into primary care

• Widening apprenticeship programmes; including Nursing

Associates, healthcare support workers, business administration,

supervisors and managers, which support career pathways and

portability across PCNs

• Ensure schemes designed to support the workforce in improved

productivity & maturity of PCNs

• Improve undergraduate placement capacity in primary care

• Increase fellowship opportunities for primary care clinicians, linked

to service and care delivery improvement.

• Foster multi-professional and systems-wide leadership including;

confident leadership development programme for Federation leads,

OD support for PCN leads and Clinical Directors, Advanced Clinical

Practice and continuous quality Improvement

• Ensure each PCN has robust workforce plans; including workforce

planning, benchmarking and modelling and well developed

organisational development capabilities

• Harness the full potential of Training Hubs to create a shared vision

of education and training across community and primary care

• Year one of the existing NW London Primary Care Workforce

strategy focused on core areas to develop general practice.

However, it recognised the need to integrate with plans to

transform the wider primary, health and social care workforce

to ensure system sustainability.

• Using a tiered approach, our aims were to;

• Support networks of practices to own workforce benchmarking,

planning and modelling by facilitating change management

capacity and utilisation of workforce modelling tools

• Create a framework to improve recruitment & retention of key

(GP and general practice nursing) primary care roles, including

supporting the sessional workforce.

• Drive forward recruitment, retention & integration of new

primary care roles.

• Support the embedding of national career frameworks and

development of career pathways for both clinical and non-

clinical staff

• Sharing of best practice underpinned all our programmes of

work

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I: Planned engagement with key stakeholders

• Structured engagement across the staff working in Primary Care, and the teams to deliver coordinated care across PCNs, will be crucial.

• Objectives of engagement:

• Ensure staff understand the reasons behind forming PCNs and the benefits to be delivered

• Ensure staff understand how changes can improve existing ways of offering patient care

• Engagement methods:

• GP Forum meetings

• Bespoke meetings with current employers of staff in PCNs

• Engagement events across new network boundaries

NWL Primary Care Networks (PCNs) Public & Patient Groups

• Patient and carer involvement is key This should include participation in decision-making, goal-setting, care design, quality improvement, and the measuring and monitoring of patient safety.

• Objective of engagement:

• Ensure the general public, patients and their carers are consulted at key stages during the PCN roadmap

• Engage people on the use of the digital front door, the self care programme, having consultation and interventions from staff other than GPs and understanding that services will be provided across the PCN

Engagement methods:

• Develop communication plan in conjunction with Healthwatch ( that provides public messaging across multiple streams)

• Review of Patient Participation Group in each PC network to create a PPE network forum for each PCN that involves people in the changes outlined in the objectives

• Local authorities and other partners have an important role in the development of local integrated care, including integrated commissioning. Their awareness and active support for the integration of services into PCNs will be critical to the success of their development.


• Support H&WBs to become vocal local champions for the development of PCNs

• Ensure Local Authorities and other partners are able to participate in decision-making at key points of the PCN development roadmap


• TBC – existing forums through which the NHS engages with H&WBs

Health & Wellbeing Boards (H&WBs) Other NWL providers

• Key programmes taking place across the HCP, such as outpatients transformation, are dependent on PCN development and will affect current ways of working for secondary care providers. Community services are key allies in delivering integrated care across the networks


• Engage community and secondary care stakeholders in PCN development

• Consult secondary care on key changes to ways of working arising from PCN development and ambition


• HCP Board and governance arrangements across HCP programmes

• Bespoke engagement meetings

• Regular Pan-NWL briefings

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Documents

Meeting name: Ealing PCCCPrimary Care and NWL’s ambitions • A vision and our aspirations for primary care across NWL • The delivery model, and models of care that reflect the