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SWL Primary Care at Scale9th May 2018
Start well, live well, age well 1
Att. 5(i)
What we want to present today
• The SWL case for change; the issues general practice is currently facing, and what needs to be addressed to move to a thriving future state
• The SWL framework for primary care at scale; our overarching framework which has been developed and tested bottom up with practices and which all CCGs are working to implement
• Our plans for delivery; setting out the areas we will focus on in 18/19 and why we have chosen these, how we will oversee delivery, and what will be different in six and twelve months’ time
2
THE CASE FOR CHANGE 3
Primary care now – Surviving?
Workforce:• Inability to recruit
to most staff groups• Significant
proportion of SW London primary care staff coming up to retirement age
Estates and IT:• Many practices
operating out of poor estate
• Lack of investment and fragmentation in IT systems and support
Quality Issues
Demand:• Patient expectations• Frailty and complexity• Shift of care from acute to
primary care
Financial:• Funding not kept pace
with demand• Rising cost of provision
4
Primary care future – Thriving!
Workforce:
• New roles• Supported,
empowered workforce
• Feeling valued
Estates and IT
• New commitment to primary care estate
• Online General Practice• System interoperability• Safe sharing of data and
information
Quality of Care, good clinical governance and systems of clinical
quality improvement
Demand• Self-management, education,
prevention, social prescribing• Technology solutions• Alternative operating models
Financial• Transformation funding• Operating at scale to
reduce costs
Resilient general practice,operating at scale
and harnessing opportunities
5
THE SWL FRAMEWORK FOR PRIMARY CARE AT SCALE
6
We have developed a framework for primary care at scale in SWL
7
Most complex patients
Primary care network – 30-50k patientsAt scale MDT working with community services and social care –“locality teams” – key mechanism for integrating services
Core general practice unit – 7-10k patientsSufficient scale to enable safe rotas and cover, and to utilise a skill-mixed clinical teamSmall enough to retain knowledge of individual patients to ensure clinical efficiency and personalised care
Staff work across these functions, coordinated to
ensure continuity for patients
Borough level – 200-400k patientsAt scale services to support core primary care e.g. quality improvementCould have a role in coordination of primary care networks
Integrated care system Primary care at the centre of a wider integrated care system
Primary care “voice” in the ICS through Clinical Leadership,
Federations / primary care networks
Management functions–30k plus patientsProvision of back office functions at scale across practices, improving efficiency and reducing costs
This framework will change how primary care works in the future
Current landscape in East Newland*
• Population of 50k served by 8 practices, a mix of single handers, small practices and one larger practice
• Each individual list-based practices and partnerships
• Variable access and quality across practices
• Increased numbers of working age adults accessing urgent care through ED
• Workforce, morale, recruitment and estates issues; resilience/failing practice issues
• New risks from private online GP providers (making current business model unviable)
Future landscape in East Newland
• Population of 50k served by primary care network, with shared strategy and leadership
• GPs and primary care professionals working in clinical teams with around 8k population, providing continuity of care
• Locally defined complex patients in MDT• Patients triaged and treated according to
need, using range of F2F and online tools; all patients get same day access if wanted
• Equitable access to comprehensive service offer across population
• Resilience in model with greater staffing, leadership and proactive/reactive ability
• GP and primary care workforce have increased satisfaction and work-life balance; better recruitment and retention rates
8* fictional location!
OUR PLANS FOR DELIVERING THIS CHANGE9
Our plans are based on bottom up engagement with practices and providers
• We believe that primary care at scale will only be successful if it is driven by general practice• CCGs have invested time and resource in engaging with practices to understand how they want to work together
in the future and how the transformation resource can best support this• CCGs have tested our emerging framework with a number of local groups and feedback is generally positive;
practices are beginning to recognise there could be benefits of working in this new way
All Croydon GP Networks, Croydon GP Open Meeting (all practices), Croydon
Primary Care Commissioning Committee
In addition, there has been engagement at SWL level with London LMCs, the SWL patient reference group, and discussions on primary care through the SWL grass roots engagement programme
Sutton Plenary of Members, Sutton practice managers forum, all locality groups, Sutton practice nurses forum, locality leads meeting, Sutton Primary Care Commissioning Committee, LMC, Sutton Federation
Merton CCG clinically led workshops, Merton Federation strategy away days with representation from all practices, Merton practice managers forum, further engagement with CLCH, LA, CEPN, PPGs, Merton Voluntary Services Council
Richmond Primary Care Committee, Richmond GP Alliance, Surrey and
Sussex LMC
Kingston Primary Care Committee, Kingston Council of Members,
Kingston GP Chambers, Surrey and Sussex LMC
Wandsworth locality forums, Wandsworth whole members forum
10
We are not starting from scratch; we have already delivered initiatives which contribute to our primary are at scale vision
11
• Six federations that are co-terminus with CCGs; whilst at varying stages of development they deliver a range of services including extended access, MSK and enhanced care planning
• Most practices are members of their federations, and there is engagement with membership
• Federations have been established as organisations with a leadership structure
• All federations have a board of directors, including clinical and non clinical members
• Information sharing agreements are in place across CCGs and there are systems in place to support cross borough services such as extended access
• ETTF is supporting development of IM&T systems to support interoperability
• Purchasing of software licenses to enable cross organisation booking (around access)
• The resilience programme has involved federations/CEPNs contacting practices to understand their needs and issues
• Local practice manager handbook in development to support practices managers
• Skill-mix audit and vacancy audit has been completed by a number of practices across SWL
• Clinical pharmacists working at scale to support changing skill mix and ways of working
• Work to standardise induction and training packages for practice nurses
• Wandsworth Federation runs a quality improvement service to support practices with CQC requirements
• Social prescribing services being piloted in a number of CCGs
• “Time for Care” programme which is supporting practices to look at more efficient ways of working
• Workflow optimisation training for practices
Federations IT systems
Workforce development Quality improvement at scale
We have self-assessed against our framework and identified the following areas of focus
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Our engagement has shown that the key part of theframework which needs development is the “primary carenetworks”.
Practices and CCGs have identified the following areas whichthey are interested in working on in 18/19, to supportdevelopment of primary are networks:
1) Population based comprehensive care: focussing on thedevelopment of locality MDT working, ensuring theprimary care networks are working at scale to meet theneeds of their population. This is a key mechanism fordelivering integrated care
2) Organisational capabilities: exploring opportunities fordelivering back office functions at scale across a primarycare network. This could involve IT, HR and a range of otheradmin functions
3) Workforce and wellbeing: understanding the currentworkforce skill mix, and vacancies, across a primary carenetwork and exploring how the workforce could bedeployed differently. Empowering the workforce andsupporting them to think about opportunities for workingdifferently, as well as exploring opportunities for at-scaleschemes to improve workforce wellbeing
Most complex patients
Primary care network – 30-50k patientsAt scale MDT working with community services and social care –“locality teams” – key mechanism for integrating services
Core general practice unit – 7-10k patientsSufficient scale to enable safe rotas and cover, and to utilise a skill-mixed clinical teamSmall enough to retain knowledge of individual patients to ensure clinical efficiency and personalised care
Staff work across these functions, coordinated to
ensure continuity for patients
Borough level – 200-400k patientsAt scale services to support core primary care e.g. quality improvementCould have a role in coordination of primary care networks
Integrated care system Primary care at the centre of a wider integrated care system
Primary care “voice” in the ICS through Clinical Leadership,
Federations / primary care networks
Management functions–30k plus patientsProvision of back office functions at scale across practices, improving efficiency and reducing costs
We have self-assessed against our framework and identified the following areas of focus
13
The areas which practices identified for development through our engagement work align to the areas identified through an internal self-assessment against the SCF development framework.
1) Population based comprehensive care: this is an area of early stage development and therefore an area to ensure we see rapid progress
2) Organisational capabilities: this is an area of early stage development. We see this as a fundamental building block of other areas of the framework and it is therefore important that we make progress on this area in 18/19
3) Workforce and wellbeing: this is an area where work is already more established and can therefore act as a springboard to help move forward at pace. It is also a key challenge for most of our practices so forms a common goal / area of need which can help bring people together
We also self assessed at being “early stage” in effective governance and system partnership. However, we feel that progress in these areas will be more difficult until we have some more of the building blocks in place. Development of these areas of the SCF framework are therefore likely to follow in 19/20, which also aligns to the timescale over which wider SWL ICS conversations will be taking place.
Pop based comprehensive
care
Systems and information
Quality improvement
Organisational capabilities
Workforce and wellbeing
Effectivegovernance
System partnerships
Mid stageEarly stage Advanced stage
These are some examples of what we will deliver in 18/19 to drive change
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• “Working at Scale Conferences” to continue engagementwith practices and reinforce the opportunities of Working atScale
• Leadership development to support development of primarycare networks and further development of Federations
• Analysis of current General Practice Back Office functionsand development of future integrated Back Office operatingmodel, building on scoping work in 17/18
• Continued development of extended access services tointegrate into wider urgent care system
• Public health profiles produced for primary care networks, tobetter understand health needs and identify areas whichprimary care networks should focus on
• Using the information from the profiles, networks will beginto identify areas of focus for service development
• Support to ensure profiles are developed and data is sharedin a safe way, compliant with General Data ProtectionRegulations
• Work with networks to complete workforce mapping and gapanalysis, and develop recruitment and retention plans, aligned toSWL workforce projects
• HR advice and production of standard documents to supportemployment across practices
• Continued roll out of clinical pharmacist roles; successful bidsthroughout SWL have encouraged practices to start formingnetworks of collaborative working and provided a foundation forpractices to share members of staff across multiple organisations
• Work with lead nurses to explore opportunities for a practicenurse “bank” to support at scale working
• Legal services to produce MOUs and other documentsrequired to enable collaborative working across networks
• Programme and Project Managers to facilitate change inprimary care networks and share learning across SWL
• Review of IT Infrastructures, including making safe existingand new data sharing agreements, compliant with GeneralData Protection Regulations
• Roll out of Online Consultation services, including videoconsultations to help networks manage demand in new ways
• Digital interoperability phase 1 and business case for phase 2
Organisational capabilities and development Population based comprehensive care
Workforce Enablers
Detailed CCG level transformation initiatives can be found in Appendix 1
• In SWL we have taken an open and transparent approach to agreeing how the transformation money will be split across CCGs
• We held a SWL Committee in Common meeting in public on 27th March 2018
• The Committee in Common agreed an approach based on “levelling up” the amount of transformation funding each CCG will receive in 18/19
• Each CCG will receive £5.41 per head, to deliver extended access services and drive primary care at scale transformation
• All our funding will be allocated to CCGs to drive our bottom up approach to transformation; where it makes sense to do so, we will pool funding to make better use of our resources
• SWL are not seeing this transformation money as isolated funding; we are using it to align and complement other funding sources so that we make progress at pace towards our vision. More information on this can be found in Appendix 2
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The SWL Committee in Common has agreed how the transformation funding will be allocated across CCGs
16
CCCG KCCG MCCG
RCCG SCCG WCCG
SWL Transforming Primary Care Delivery
Group
SWL Alliance SMT
• The SWL TPC DG brings together CCGs, providers, LMC and other stakeholders to drive delivery of the TPC programme
• This forum will provide opportunities for collaborative working, and will review progress and options for accelerating transformation over the next 12 months
• Spend and delivery will be monitored on an ongoing basis by the SWL Alliance SMT
We have the infrastructure and governance in place to deliver our plans
• CCGs will follow local governance arrangements to oversee the development of local plans
• This will support our bottom up approach to development and implementation
What we will have delivered by month 6 and month 12
Phase 1: Months 1-6
• Practices will recognise the network that they belong to, and understand the demographics of their population• Networks will have identified their area of focus for development e.g. delivery of back office functions, workforce
planning• Federations will understand how they can work with their networks to deliver patient improvement initiatives,
and initiatives to support resilience and sustainability of practices• Local leaders will be identified and have a vision for supporting the delivery of primary care at scale in their
network
Phase 2: Months 6-12
• Federations will have an overview of the needs of their networks, both in terms of patients as well as theirpractices and primary care staff
• Networks will have identified opportunities for working at scale and have plans in place for these areas; pilotswill have started in some networks
• There will be an infrastructure for federations to deliver activity through networks or practices• The whole system will be familiar with their local primary care at scale plans
Phase 3: 19/20
• Now that networks are in place, learning from the models across SWL will be shared to accelerate furtherimplementation and spread of working at scale initiatives
• Improved patient outcomes through practices working collaboratively to address population health issues, andthrough reduction in practice variation
• Improvement in staff wellbeing and retention; workforce will feel empowered and supported17
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We have thought about what success looks like for commissioners, providers and patients. We have had some initial thoughts about how we will measure success, to ensure we are delivering the expected benefits. This will be further co-produced with practices as each CCG rolls out their transformation initiatives.
Commissioning is on a population health based approach.
Providers can deliver services more efficiently through economies of scale
Delivery of the high quality proactive, coordinated and accessible care
• Practices are resilient and sustainable, as a result of collaborative working to manage risks and issues
• The workforce is well supported and there are opportunities for learning and development, to improve recruitment and retention
• Patients have equal access to high quality primary care services regardless of the practice where they are registered
• Patients have access to a broader range of skills in general practice
Commissioner Provider Patient
• Improved CQC performance• Staff satisfaction survey• Reduction in administrative
workload
• Improved patient satisfaction• Improved carer satisfaction• Increased ability to self manage
Out
com
eKP
Is
• Improvement in patient access• Improved CQC performance• Reduction in variation in LTC
management• Reduction in inappropriate A&E
attendances
We will measure our success to ensure we achieve the expected outcomes
APPENDIX 1CCG TRANSFORMATION FUNDING INITIATIVES
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Area of focus Amount Progress by Month 6 Progress by Month 12
1 OD Working at Scale Conferences to reinforce the opportunities of Working at Scale.
£20,000 • 1. First wave of practices have identified synergies for Working at Scale.
• 2. First wave of practices providing peer support to second wave of practices.
• All Croydon practices having had OD support to develop and deliver Working at Scale capability. This will enable greater capacity for practices to focus on Working at Scale.
2 Backfill for practices who are interested in Working at Scale to attend/engage in meetings with peers in Croydon networks.
£30,000 • Established GP champions who will drive identification of operating model changes in their practices (i.e. skills audit, population health, patient flows etc).
• Implementation of identified Working at Scale operating model will have been tested with lessons learned for Croydon peers.
3 1. Recruitment
2. Croydon GP Collaborative Staff
Working at Scale Programme Manager x 2 Working at Scale Project Officers x 2
£5,000
£210,000 • Advertised, interviewed and recruited staff.
• Staff in place delivering Working at Scale plans.
4 Accelerating leadership development for the new Croydon Primary Care networks to support Working at Scale (as current network boundaries will change).
£25,000 • Agreed new network boundaries and established new network leaders.
• Network leaders ensuring Working at Scale plans are delivered at pace.
5 Workforce Training/upskilling of current General Practice workforce.
£15,000 • Identification of staff requiring skill mix. • Skill mix training completed.
• Upskilled clinical care delivery post training based upon population health
6 EnablersIT Infrastructure Enterprise-wide IT platform Enterprise-wide telephone solution Enterprise-wide EMIS integration System-wide interfacing with partners (access/Urgent Care)
£300,000 • Analysis and design of IT infrastructure • IT infrastructure implemented
Total Investment £605,000
Transformation funding initiatives - Croydon
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Transformation funding initiatives – KingstonOrganisational capabilities Amount Progress by Month 6 Progress by Month 12
1 Engagement with practices - to scope work around sharing back office functions• Federation to engage with practices to identify at scale back office function• Initiatives for shared back office functions developed.
£30,000 • Scoping work completed and agreement on areas for joint working
• Implementation plan for delivering shared back office functions in place
2 Implementation of primary care at scale – pilot PCAS initiatives Q2/Q3, workforce development etc.• Identify initiatives for at scale working based on population health needs• Develop network plans for implementing PCAS initiatives.
£30,000 • Scoping work completed and agreement on areas for joint working
• Network plans for delivering PCAS initiatives
3 Primary care networks – development of 4 networks aligned to MDT localities, pilot new contract forms, develop performance dashboard• Exploration of contract models required for PCAS• Development of dashboard to support PCAS planning
£200,000 • Primary care network 1 of 4 aligned to MDT locality
• Primary care network 4 of 4 aligned to MDT locality
• Options for contracting PCAS models shared• Metrics to be included in dashboard agreed
4 Workforce Strategy – Work with networks to develop recruitment and retention plans, pilot new ways of working across general practices, networks and borough wide, aligned to SWL workforce work• Skillmix and workforce audit completed• Gap analysis • Recruitment and retention plan
£80,000 • Workforce mapping • Recruitment and Retention plans in place for 19/20 aligned to SWL work
• Gap Analysis of workforce against population health need
5 Learning and Development - Training to support primary care networksunderstand PCAS, analyse the data in the performance dashboard, support new ways of working• Work with federation and CEPN to identify gaps in skills needed for working at
scale• Commission additional training for working at scale
£40,000 • Training needs identified Training plans for network
6 Project and Change Management Support - Procurement of expertise, allocation of resources, coordination with practices and CCGs, contract support, monitoring and reporting, evaluation INCLUDE PROJECT MANAGEMENT IN OTHER SECTIONS
£25,000 • Strong project management in place, with progress being made according to plans
• Strong project management in place, with progress being made according to plans
Total Investment £405,000
Transformation funding initiatives - Kingston
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Transformation funding initiatives – MertonArea of focus Amount Progress by Month 6 Progress by Month 12
1 GovernanceRefresh MHL Governance to reflect membership mandate and each PCH (Each of the four primary care networks)
£25,000 • New integrated governance framework and board assurance framework
• Identify working groups within each PCN• Aligned federation board member and clinical
directors within each PCN
2 Comms and engagement Comms and engagement strategy to include all internal and external stakeholders
£25,000 • Development of strategy • Implementation of agreed strategy
3 WorkforceSkills gap analysis (Use of STP workforce tool, Eden bridge apex software tool and input from Merton CEPN
£25,000 • PCN recruitment and retention plan (development)
• PCN recruitment and retention plan (implementation)
4 WorkforceStaff bank with subsidiary PCN banks
£10,000 • Enhanced staff bank and reduced vacancy and locum rates (development)
• Enhanced staff bank and reduced vacancy and locum rates (implementation)
5 WorkforceAchieve functional alignment of HR, Health and safety and wellbeing services
£10,000 • Consultation with various stakeholders to agree priorities
• PCN staff handbook, HR policies, Health and safety and alignment of HR where possible
6 WorkforceDevelopment of inter-practice SLAs for the provision of staff/shared staff for an agreed function across PCNs
£10,000 • Inter-practice SLAs to support sharing staff across multiple practice sites.
N/A
7 Back office Develop a centralised procurement facility for practices to access
£10,000 • Scoping potential opportunities across Merton
• Development of procurement portal for all practices
• Agreed process for making new procurement queries not currently available
9 Population healthDevelop fit for purpose Health Informatics (e.g. population segmentation data) to identify our population health priorities to develop integrated services for specific cohorts of patients.
£10,000 • Population Segmentation Data at 50,000 patient level. i.e. Locality and Borough Level.
• Population Segmentation Dashboard Delivery
10 PILOT: Acute GP Home visiting service. Development of medical model and business case
£10,000 • An acute Home visiting GP Service will be delivered.
• Partnerships will be developed to support early discharge, intermediate care bed work etc.
Transformation funding initiatives - Merton
22
Area of focus Amount Progress by Month 6 Progress by Month 12
11 Service deliveryProactive Care Home Ward Rounds. Back-fill required to develop medical model and business case.
£10,000 • Develop business model • Improved patient experience
• Reduced A&E attendances, LAS conveyances and LOS.
• Improved partnership working between providers
12 Service deliverySame day access model across pilot sites
£20,000 • Work with current provider, CCG and practices to agree pilot sites and new model
• Begin pilot of first PCN site for same day access
13 WorkforceDelivery of the Merton Clinical Pharmacist Programme. Back-fill required supporting with mobilisation.
£9,000 • Agree SLAs and working groups • Begin implementation
14 LeadershipUpskill practice managers to support PCAS
£28,000 • 8 places (2 per PCN) for practice managers to undertake a 1 year diploma in advance primary care management
• Completion of 12 month advanced diploma
15 PILOT: Develop and deliver a PCN primary care based integrated paediatric & geriatric clinics. Back-fill required for stakeholder engagement, to develop medical model and business case.
£30,000 • Scoping and working up PCNs • Begin stakeholder engagement and develop medical model business case
16 ODMember practice engagement in at scale working – including facilitation for working groups and stakeholder engagement
£97,000 • Begin cycles of engagement with practice managers and clinicians to ensure there’s buy-in to at scale working
17 Back office Legal, HR and finance advice - enable delivery of all workstreams and support the development of MHL as a PCAS provider organisation
£25,000 • Identify projects, working groups and practice groups.
• Agree partnerships between PCNs, Federation and CCG
• Continued support from HR, Finance and legal firms to enable delivery and management of PCAS services
Total Investment £354,000
Transformation funding initiatives - Merton
23
Transformation funding initiatives – KingstonArea of focus Amount Progress by Month 6 Progress by Month 12
1 Implementation of primary care at scale – pilot PCAS initiatives Q2/Q3, workforce development etc.• Identify initiatives for at scale working based on population health needs• Develop network plans for implementing PCAS initiatives.
£20,000 • Scoping work completed and agreement on areas for joint working
• Network plans for delivering PCAS initiatives
2 Workforce Strategy – Work with networks to develop recruitment and retention plans, pilot new ways of working across general practices, networks and borough wide, aligned to SWL workforce work• Skillmix and workforce audit completed• Gap analysis • Recruitment and retention plan
£90,000 • Workforce mapping • Recruitment and Retention plans in place for 19/20 aligned to SWL work
• Gap Analysis of workforce against population health need
Total Investment £110,000
Transformation funding initiatives - Richmond
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Transformation funding initiatives – SuttonArea of focus Amount Progress by Month 6 Progress by Month 12
1 LeadershipEstablish Programme OfficeBuilding on the successes of the Sutton Health and Care at Home programme, we would want to engage PPL Consulting to set up and run the Programme Office
£100,000 • Detailed programme plans in place • Business case setting out plans to mainstream at scale projects in 2019/20
2 Workforce DevelopmentDelivery team (2 x B8A) responsible for working with practices to identify and pilot at scale projects
£130,000 • Appointed 2 Delivery Managers • Identified projects to mainstream based on initial pilots
3 MDT DevelopmentCase manager nurse (2 x B7) – in addition to the 2 x B7 in existing contract. This is to drive forward MDT working across all localities.
£115,000 • Appointed additional nurses, 4 in total to lead proactive MDTs
• Developed the Sutton Health and Care optimum model for MDT working across Sutton Health and Care bringing together the proactive and at Home work programmes
4 Workforce DevelopmentEngagement by GP Federation
£20,000 • Proposal developed for shared staffing at scale
• Proposal developed for shared business services with delivery plans in place
5 Organisational DevelopmentCommission expert support to show case what has been achieved elsewhere through exemplar sites.
£50,000 • 2 Engagement Workshops delivered with commitments to pilot new ways of working eg spirometry hubs
6 Contract DevelopmentLegal guidance regarding contracting options
£20,000 • Scope opportunities for MCP contracting model
• Options for contracting forms considered by Governing Body
7 MDT DevelopmentOperational support for integrated cross-organisational working (2 x B5)
£80,000 • Administrative support to MDT process • Effective MDTs operating in each locality
8 Patient & Public EngagementCommunication and engagement
£20,000 • Testing patient and staff experience of new projects
• Reshaping delivery based on feedback and recommendations presented to inform the business case
Total Investment £535,000
Transformation funding initiatives – Sutton
25
Transformation funding initiatives – WandsworthArea of focus Amount Progress by Month 6 Progress by Month 12
1 Workforce Development and Retention £45,000 • Develop (in conjunction with CEPN) a diverse recruitment and retention strategy.
• Develop an online sessional GP pool enabling practices to source sessions directly reducing agency spend and maintaining a consistent temporary workforce
• Develop standardised recruitment, induction, and training materials supporting a positive and structured experience for the candidate at the outset
• Implementation of agreed strategy • Agile working implemented at PCNs level • Develop a practice manager preceptorship
programme to support new practice managers
2 Project Management Programme management lead role to manage project documentation. This will incorporate the workforce SME role plus governance and BI SMEs.
£143,000 • Employment of 1 Programme manager/SME to lead governance and project assurance • 2 SME workstream leads – workforce and & BI
3 Working GroupsPractice representatives who will be responsible for reviewing, recommending, and implementing the agreed solution.
£30,000 • Identified working group members • Clear evaluation process and TOR
• Implementing agreed plan with identified working group members
4 Practice Protected timeBack fill hours (based on patient capita) for practices to enable PCAS discussions / specialist support e.g. facilitators.
£107,500 • Develop PCN plans collectively with PCN members
• Initiating plans as PCNs• Identifying areas of clinical focus• Engaging with members of PCN and federation • Working with all stakeholders – including LMC,
CCG etc
5 Quality systemQuality system expertise and systems (policies, procedures, etc) which will require significant oversight / administration support.
£50,000 • Standardised policy and procedure directory
• Establish the governance framework
• Ensuring agreed policy and procedure directory and governance framework are being implemented
• Explore local apprach to DNAs and entry into PC via other NHS pathways
Transformation funding initiatives - Wandsworth
26
Area of focus Amount Progress by Month 6 Progress by Month 12
6 Legal & Finance AdviceExternal professional advice and guidance (e.g. contracts).
£17,500 • Identify projects, working groups and practice groups.
• Agree partnerships between PCNs, Federation and CCG
• Continued support from Finance and legal firms to enable delivery and management of PCAS services
7 ProcurementDevelopment of centralised purchasing, directory of suppliers, etc
£10,000 • Directory of suppliers • Identify procurement vehicle to support
delivery of PCAS
• Develop working relationships with NHS agency EG NHS property service, NHS pensions etc. in conjunction with SWL HCP
8 Nurse Training – workforce Nurse training development
£20,000 • Develop 5 year plan in accordance with GPN 10-point plan
• Identify specific staff who want to develop
• Developing new out-of-hospital pathways with a greater range of nurse-led services available to patients in a nearby practice. Eg epilepsy, diabetes, etc
9 GP Network PilotsBusiness Intelligence, back office and diabetes hub pilots
£20,000 • Create a GP network to enable non-participating clinical correspondence practices to be supported by participating clinical correspondence practices to deliver the solution.
• Scope BI
• Diabetes hubs go-live• BI roadtesting – working with PCN to evaluate
the data
10 GP Network - Leadership and Governance GP networks leadership structure and a robust governance framework
£94,500 • Exploring the challenges faced by practices at PCN level
• Develop a leadership structure which includes existing structures identifying the gaps which require new or increased resource
• Establish a strategy that is clinically-led, informed by system engagement and includes SMART objectives where appropriate
• Strategy is available and understood throughout the organisation
• Identify any recurrent funding needs and how this will be me
Total Investment £537,500
Transformation funding initiatives - Wandsworth
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APPENDIX 2OTHER FUNDING SOURCES SUPPORTING PCAS
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Funding source How this is supporting primary care at scale Resilience Programme Practice support delivered at scale by federations and CEPNs. Scoping of back office functions and workforce
needs across vulnerable practices, and development of at scale solutions.
Medical Assistant and Care Navigator Training
Programmes designed and delivered at scale across boroughs to standardise processes to facilitate collaboration across practices. Care navigation being offered at a network level in some areas.
Online consultation Initiatives are being sourced for delivery at scale, with primary care leading on developing the appropriate solutions for their population
Provider Development Funding (GPFV £3ph)
Supporting at scale working in a variety of ways including; development of social prescribing models, at scale clinical pharmacy team, health education and coaching, at scale Quality Improvement services
Locally commissioned services
LCSs are also being used to support at scale working e.g. over the next 6 months one CCG will be commissioning practices to work at scale to deliver education programmes, and commissioning an at scale respiratory diagnostic service
Commissioning approaches For example, Kingston Medical Services brings together locally commissioned services into a single contract which supports at scale working. Wandsworth CCG have commissioned an MCP, which is led by the Federation. In Sutton CCG, there is a PMS Premium KPI for Locality Development Scheme which means every practice is contracted to actively participate in development of at scale plans and delivery of MDTs
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In SWL, we are not seeing the transformation money as an isolated funding source. We are using other funding sources to drivedelivery of primary care at scale, to ensure all our resources are supporting the same strategic vision. This table gives some examples of other funding sources supporting primary care at scale.
We are using other funding sources to support primary care at scale
APPENDIX 3HOW OUR FRAMEWORK ALIGNS TO SCF NEXT STEPS
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31
SCF development framework area How will primary care networks support delivery of this SCF area?
How will borough level services support delivery of this SCF area?
Pop based comprehensive care
Clinical leadership has responsibility for performance, patient outcomes and reducing clinical variability across all practices. Consistent clinical pathways, administrative processes and appointment type mean that all populations experience the same quality of access and care
• Practices in a PCN will align their processes
• PCNs will plan and design MDTs based on their combined workforce and population need
• Wider skill mix across PCN will give patients options around appointment type to better meet need
• Borough level responsibility to analyse population health outcome information
• Support planning and delivery of care to meet patient need
Systems and information
Comprehensive, accurate and real time data reflecting patient needs, performance, quality and outcomes is available at different scales of the system. Information is the basis for operational delivery, including workflow optimisation, capacity planning and demand management
• PCNs receive information on performance to support workforce planning from borough level analytics
• Analyse and interpret information on patient needs, performance, quality and outcomes to make improvements.
Quality improvement
Patient centred QI methodology and approach is embedded within the culture, practiced by all staff across all practices. Continuous improvement of the quality, safety and efficiency of services takes place as part of every day operations as well as transformation projects
• Practices in a PCN will work with borough level provider to engage on quality improvement and make continual improvements to services
• There will be a borough level approach to quality improvement, engaging with practices through PCNs
Our framework aligns to the SCF development framework
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SCF development framework area How will primary care networks support delivery?
How will borough level services support delivery?
Organisationalcapabilities
Fully formed business capabilities, constituted of robust systems and processes and resourced by professional experts. Legal advice, procurement and financial expertise is readily available to support service development and contractual decisions
• Alignment of back office functions across PCNs to ensure practices have access to legal, financial expertise etc
NA
Workforce and wellbeing
Policies, procedures and contracts are consistent, so that all staff are treated and supported equitably. This is reinforced by specialist HR expertise, able to advise and support staff in areas such as appraisal, work plans, pay and performance HR also works with senior leaders to plan to workforce needs of the organisation and implement a recruitment and retention strategy to meet them
• Practices in a PCN will align theirpolicies and procedures
• Workforce planning across a PCN to support efficient use of resources and retention of staff
• Understands the workforce and skillmix of practices and coordinates activities relating to recruitment and retention and staff wellbeing
Effective governance
Robust governance structures are in place and understood by shareholders and stakeholders. A multidisciplinary, highly skilled executive team is in place with representation from each practice / network.
• The PCNs will have a clear relationship with the leadership teams of the borough level organisations
• Multidisciplinary organisation • that represents the needs of
their practices and population,and has the mandate to work in this way
System partnerships
Having coalesced into a well formed, mature organisational form, the leadership team is empowered to speak with a strong voice on behalf of all constituent practices with an ICS. Acts as a leader of population health and care alongside system partnership, including informing the work of commissioners
• The PCNs will have a clear relationship with the leadership teams of the borough level organisations
• Mandate from practices to represent them at system level forums and in ICS discussions
Our framework aligns to the SCF development framework
