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#GPforwardview

Practice Manager networking event

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Page 1: Practice Manager networking event

#GPforwardview

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#GPforwardview

www.england.nhs.uk/gp

[email protected]

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#GPforwardview

WelcomeWelcome and housekeepingContext settingYour priorities and questions

Running the practiceThe importance of sharingManaging workload in the practiceShare challenges & solutions

Professional developmentLeading primary care into the future - lessons so farOpportunities for sharing and developmentYour personal developmentNext steps

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#GPforwardview

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#GPforwardview

pollev.com/gpfv

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#GPforwardview

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#GPforwardview

Context-setting

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#GPforwardview

Pressures on general practice

↑ population

↑ consultations

↑ complexity

↑ costs

↓ relative funding

↓ relative workforce

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#GPforwardviewwww.england.nhs.uk/gp

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#GPforwardviewwww.england.nhs.uk/gpfv

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#GPforwardview

Extra £33m included in 2016/17 contractRepeat winter payments scheme for OOH in 2016

Already actioned

Out of Hours

Payment to all practices in April 2017 and 2018 based on average

indemnity increases

Work on new scheme for OOH support with BMA

Next steps

GP Indemnity Review Group to look at cover for new members of the workforceand other more radical options

Longer term

In hours

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#GPforwardview

Training for clerical & reception staff• 5 year fund: total 80p/patient (eg £8,000 for 10,000 list practice)

• 2016/17 portion allocated to CCGs Sept 2016• Full information:

www.england.nhs.uk/gp/gpfv/redesign/gpdp/reception-clerical/

Online consultations• 4 year fund: total 80p/patient • First portion in Apr 2017• Full information:

www.england.nhs.uk/gp/gpfv/redesign/gpdp/consultation-systems/

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#GPforwardviewwww.england.nhs.uk/gpfv

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#GPforwardviewwww.england.nhs.uk/gpfv

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#GPforwardview

Make GP attractive again

Expand the Medical Workforce5,000 Net WTE doctors in general practice by 2020/21

Encourage Recruitment

RetentionReduce workload Induction & refresher schemeBursaries in under-doctored areas Retainer Scheme Leadership training opportunitiesTraining Hubs

Flexible career schemesCareer coaching for senior GPsGP Health Service

Work with medical schoolsIncreased training places250 Post-CCT fellowshipsMajor campaignsCSU Marketing support International recruitment

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#GPforwardview

Develop the workforce5,000 additional staff by 2020/21

• Major new practice nursing review underway

• £15M to be invested

NURSES

• 3,000 new mental health therapists• Focus on longterm physical conditions

MENTAL HEALTH

Training 1,000 physician associates by 2020• Regulatory and indemnity

enablers

PHYSICIAN ASSOCIATES

£6m of new support over 4 years• Expanded national network• Professional development

PRACTICE MANAGERS

Current £31m to pilot 470 pharmacists in >700 practices, • Plus new £112m for additional

1,500 pharmacists by 2020 (a pharmacist / 30,000 patients)

• Clinical pharmacists in 111 hubs

PHARMACISTS

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#GPforwardviewwww.england.nhs.uk/gpfv

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#GPforwardviewwww.england.nhs.uk/gpfv

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#GPforwardviewwww.england.nhs.uk/gpfv

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#GPforwardview

Simplify reporting and regulationStreamline payment systemsMove away from micro-incentives

Greater specialist support

Self-help and GP Online

Better sign posting• Care navigation• Social prescribing• Minor ailments• Remote triage/care• Open access AHPs

Reformed 111/Urgent Care

Collectiveworking and MCP contract

GP PRACTICE

Community services

Changes to

Standard Contract

HOSPITAL

Access hub

Demand Management

Practice Resilience ProgrammeTen High Impact ActionsDevelopment Programme

Tools to measure & plan workReceptionist & clerical training

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#GPforwardviewwww.england.nhs.uk/gpfv

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#GPforwardview

Where are we now?Investment secured and in planning guidance

Indemnity till April 2019 (OOHs ongoing)

Induction & Refresher / Retainer Schemes

£20K Bursaries & 250 Post-CCT Fellowships

International Recruitment Pilots

470 Clinical Pharmacists (Phase 2 soon)

National GP Health Service from Jan 2017

Practice Resilience Scheme

General Practice Development Programme

Medical Assistant and Care Navigation

Standard Contract Changes / Interface Group

Expansion of capacity through Access Hubs

MCP Framework and voluntary contract

GMC/CQC/NHSE joint work

Pipeline 800 of premises schemes

GPFV Scrutiny and Architecture in place

Medical School places increased

Vulnerable Practices Scheme

Leadership Training Opportunities (400 pa)

Training Hubs

111 Online Clinical Assessment Hubs

Practice Manager Training Consultation

Capacity Planning Tools being rolled out

BMA Approved Lease with package

COMMUNICATION

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#GPforwardviewwww.england.nhs.uk/gpfv

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#GPforwardviewwww.nhsalliance.org/making-time-in-general-practice/

[email protected]

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#GPforwardview

Pressures from bureaucracy

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#GPforwardview

Self-rating by GPs

5,128 consultations [email protected]

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#GPforwardviewNationally [email protected]

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#GPforwardviewTypical practice 6,700 patients [email protected]

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#GPforwardviewwww.england.nhs.uk/gpfv

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#GPforwardview

What are the biggest challenges in running the practice productively?

What would you most like to learn from colleagues today?

Your priorities

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#GPforwardview

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#GPforwardview

What are the biggest challenges in running the practice productively?

What would you most like to learn from colleagues today?

Your priorities

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#GPforwardview

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The importance of sharing ~The GP Forward View and Practice Manager Development Programme

Welcome!

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• Practice manager development• Practice managers are a vital resource in the NHS, playing a key role

in maintaining a quality service and in redesigning care for the future. Yet they are also one of the most neglected parts of the workforce, receiving relatively little formal training or ongoing development. Many practice managers report feeling overburdened and isolated in their role, and it is often noted that the most efficient ways of working are slow to spread between practices.

• NHS England 2016

General Practice – The increasing workload

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• Practice manager development• We want to share our wide experience as business managers with our

colleagues in practice management and with others in the NHS. We want to promote excellence, provide practical support and identify examples of good practice. We will identify sources of expertise and encourage collaboration.

• We will champion the cause of practice management and the development of ever higher professional standards.

• Practice Management Network 2009

General Practice – The increasing workload

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• Aligned to 7 health organisations

• 10 high impact actions champions

• 209 CCG lead opportunities• 7,500+ Practice Managers• 70,000+ Practice Staff

• The Practice Management Network (initially supported by the Department of Health)

• Over 4,100 registered managers• 14 steering group members• 4 regional representatives

General Practice – The importance of sharing

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General Practice – The Way Forward10 High Impact Actions Champions

Active signposting - New consultation types -Reduce DNA’s -Develop the team -Productive work flows -Personal productivity -Partnership working – Use social prescribing –Support self care and

management -Build QI expertise -

2 x Co-chairs

NORTH

SOUTH

MIDLANDS AND EAST LONDON

209 CCG’s

BMA

NEW NHS ALLIANCE

IHM

RCGP

AMSPAR

NAPC

FAMILY DOCTORS ASSOCIATION

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• Performance reviews• Other resources• The GP forward view• Leader or follower ?

• General Practice Today – The Challenges

• Who’s who in your practice• Practice policies• Practice benefits

General Practice – The importance of sharing

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• Support for PM’s and a voice• Representing the profession, professional development and

primary care transformation• Support for PM’s in terms of brainstorming and problems• To ensure that PM’s are fully supported in their work and are

allowed to develop their skills

General Practice – What You Say

SUPPORT

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• Understanding the main challenges faced in surgery.

• Supporting your team to manage workload and identifying where to delegate appropriate tasks

• How does this fit into the General Practice Forward View?

• What do the Five Year and General Practice Forward Views mean to my practice.

• How can I take part in the initiatives and access funding?

• Taking a leadership role in driving improvements in provision of primary care.

General Practice – The Challenges

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General Practice – The Way Forward

In a survey of almost 2,000 people in Great Britain, the most commonly perceived barriers to seeing a GP were finding it difficult to get an appointment with a particular doctor (42 per cent), or at a convenient time (42 per cent), and disliking having to talk to GP receptionists about symptoms (40 percent).

11th October 2016

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General Practice – The Way Forward

Receptionists 'put people off seeing doctor‘

11th October 2016 Patient: "They (receptionists) sometimes think they're the doctors"

Receptionists quizzing patients about why they need to see their GP could be putting some sick people off visiting their surgery, a survey suggests. Of almost 2,000 adults questioned for Cancer Research UK, four in 10 said they disliked having to discuss their ills with office staff in order to get an appointment.

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General Practice – The Way ForwardThe PMn is in discussion with NHSE to determine how the funding of £6 million can be best utilised

AMSPAR already provide education and training with the Level 5 certificate/diploma in Primary Care Healthcare Management and offer professional membership

The NAPC with help from the PMn will be introducing an Advanced Practice Manager Programme – expected October 2017

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General Practice – The Way Forward

Share your knowledge.It’s a way to achieve immortality.Dalai Lama(1357-1419, high lama of Tibetan Buddhism)

Let’s try it once without the parachute.

Image: Cartoonresource (Shutterstock)

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C’mon guys, we’ll find someone with the answers. Just keep looking.

Image: Cartoonresource (Shutterstock)

Sharing is sometimesmore demanding than giving.Mary Catherine Bateson(*1939, American writer and cultural anthropologist)

Scientia potentia est: Knowledge is Power.commonly attributed to Sir Francis Bacon(1561-1626, English philosopher, statesman, and scientist)

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@robertvarnam

Managing workloadin the practice

Dr Robert VarnamHead of General Practice DevelopmentNHS England

@robertvarnam

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#GPforwardviewwww.nhsalliance.org/making-time-in-general-practice/

[email protected]

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#GPforwardview

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#GPforwardview

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#GPforwardview

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#GPforwardview

Bureaucracy auditcfep.net/u6k

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#GPforwardview

10 high impact actionsto release time for care

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#GPforwardview

10 High Impact Actions to release time for care

Innovations from around England that release time for GPs to do more of what only they can do.

bit.ly/gpcapacityforum

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#GPforwardview

10 High Impact Actions to release time for care

Innovations from around England that release time for GPs to do more of what only they can do.

bit.ly/gpcapacityforum

bit.ly/gpcapacityforum

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#GPforwardview

10 High Impact Actions to release time for care

Innovations from around England that release time for GPs to do more of what only they can do.

bit.ly/gpcapacityforum

Consultation auditwww.primarycarefoundation.co.uk

/audit-tool.html

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#GPforwardview

10 High Impact Actions to release time for care

Innovations from around England that release time for GPs to do more of what only they can do.

bit.ly/gpcapacityforum

Introduce new ways of working which enable staff to work smarter, not just harder. These can reduce wasted time, reduce queues, ensure more problems are dealt with first time and that uncomplicated follow-ups are less reliant on GPs consultations.Match capacity with demandAppointment systems and staff rotas are designed in order to ensure sufficient capacity is available to match patterns of demand as they vary through the week and the year. This requires an ongoing system of measuring demand and adjusting capacity accordingly. It may also involve scheduling routine work (eg annual reviews and clinical audit) for less busy times of the year. The benefits are a reduction in delays for appointments, less stress for staff and patients, and better access.Efficient processesThe application of Lean principles to measure, understand and improve common processes in the practice, in order to reduce waste and errors. Typical targets include clinical follow-up protocols, processing of letters and test results, requests from patients, staff messages and team decision making. Staff themselves often have a wealth of ideas about ways in which processes could be improved to release time. Practices who take a systematic approach to identifying and testing these generally find that this improves care for patients as well as freeing staff time for other things. The use of pre-prepared plans for managing common simple follow-up processes can improve their reliability and efficiency, freeing GP time. Common examples include management of hypertension, monitoring of tests after the initiation of new medication, and adjustment of medication doses to reach a target.Productive environmentThe physical layout within the practice is assessed for its effect on staff's productivity, and improvements are introduced which reduce wasted time. The Lean technique of 5S is the best known approach for doing this. Additionally, work can be undertaken to ensure that staff can access information needed to support their work quickly. This reduces time spent searching for information and can improve patient safety as well.

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#GPforwardview

10 High Impact Actions to release time for care

Innovations from around England that release time for GPs to do more of what only they can do.

bit.ly/gpcapacityforum

Take every opportunity to support people to play a greater role in their own health and care. This begins before the consultation, with methods of signposting patients to sources of information, advice and support in the community. Common examples include patient information websites, community pharmacies and patient support groups. For people with longterm conditions, this involves working in partnership to understand patients' mental and social needs as well as physical. Many patients will benefit from training in managing their condition, as well as connections to care and support services in the community.PreventionSome practices are fostering links with their local community and launching new programmes to improve population health and prevent disease. This spans a range of activities, including health education, promoting healthy eating and physical activity, and influencing other aspects of public health. A common feature is a focus on communities helping themselves, with statutory services providing support.Patient onlineTechnology changes are enabling patients to access their personal record online, through web portals and a growing number of health apps for mobile phones. This makes common transactions such as ordering a repeat prescription quicker for the patient and for practice staff. It also allows patients to become better informed about their health and care, and to play a more active role. With explanation and support, patients and their carers are able to check test results, the progress of investigations and referrals, read and share their care plan, and enter details of home monitoring, such as blood pressure, weight, and sugar tests. As well as being popular with patients, GP practices are reporting a reduction in workload as a result of patients using these online services.Acute episodesPractices are increasingly involved in supporting patients with minor ailments to care for themselves. This often includes providing advice and signposting to services provided by community pharmacy. Education also plays a part, with growing numbers of practies contributing to efforts to teach people about the best ways to seek help when ill. This often begins with engagement in local primary schools.Longterm conditionsFor people with longterm conditions, a more proactive approach to care is being adopted, alongside a focused effort to help people play a more active role in monitoring and managing their condition. Initiatives include supporting people to access their full medical record online, the use of health coaching in clinical consultations and the provision of training and support in the community, aiming to build the knowledge, skills and confidence for patients and carers to manage their condition. This builds patients’ own assets and quality of life, as well as reducing their dependence on services such as the general practice.

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Booking and cancellingof appointments

Ordering ofrepeat prescriptions

Access to GP records

What is Patient Online?

Over 97% of all practices in England are currently offering these online services to their patients. This was a requirement in last year’s GP contract.

This year, the BMA and NHS agreed that all practices should aim to get at least 10% of their patients signed up for online services by the 31st of March 2017.

In the North region 57.1% of practices are already offering online services.

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Why should I do it?Convenient way for patients to contact the practice 24/7

Reduces footfall

Frees up phone lines for other patients

Reduces the amount of no shows

More efficient prescription process and less prescription waste

Increases patient satisfaction and self care

Frees up valuable time for other essential tasks

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New promotional materials available

Patient Online GP online services

Order promotional materials, including posters, patient guides, leaflets, balloons, bunting and appointment cards, for free via www.england.nhs.uk/materialsforpatient/

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www.england.nhs.uk/patient-online

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#GPforwardview

10 High Impact Actions to release time for care

Innovations from around England that release time for GPs to do more of what only they can do.

bit.ly/gpcapacityforum

bit.ly/gpcapacityforum

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#GPforwardview

Running an effective & efficient practiceWhat are the challenges? What's worked for you?

1. Managing the business

2. Managing the team

3. Prescription requests

4. Incoming clinical correspondence

5. Test results

6. Using technology (eg Patient Online, etc)

7. Active signposting

8. Freeing up GP appointments (other ideas)

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#GPforwardview

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#GPforwardview

Leading primary care into the future - lessons so farDr Robert VarnamHead of General Practice DevelopmentNHS England

@robertvarnam

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@robertvarnam

Where are we heading?

What size should we be?

How do we realise the benefits of scale?

What capabilities will we need?

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@robertvarnam

Where are we heading?

What size should we be?

How do we realise the benefits of scale?

What capabilities will we need?

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#GPforwardview

Specialists

Non-specialist / failed consultantGatekeeper / door-holderKing of my castleIt’s all in me

Community services

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#GPforwardview

Self Care

Broader skillmix

Self management /

social prescribing

Emergencycare

Collaborationwith specialists

At scale

Population wellbeing management and holistic person-centred care provided by a multiprofessional team led by the GP, supported by at-scale collaboration and efficiencies.

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#GPforwardview

What is a Multi-speciality Community Provider?

General Practice

Community

Services

Outpatient

Services

Mental Health

Social Care MCP

Key Features• CCG-commissioned voluntary

contract• Place based and population

based provision of care > 100K+ patients (in 30-50K neighbourhoods)

• Focus on prevention, self-care and use of community assets

• Enhanced primary and community-based services

• Wider range of specialists developing integrated patient pathways

• New pay for performance mechanisms with gain/risk share opportunities

• Accessible and responsive urgent care• Greater resilience across practice

groups• Greater career opportunities for all staff• New organic business models in 10-15

year contracts (with right of return)Virtual MCP – alliance contract laid over

existing GP contractsPartially Integrated MCP – GMS +

Community ServicesFully Integrated MCP – One budget, one

team, one service• Intensive work with 6 aspirant MCPs

areas• Contract to be available from April 2017

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@robertvarnam

Where are we heading?

What size should we be?

How do we realise the benefits of scale?

What capabilities will we need?

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@robertvarnam

Where are we heading?

What size should we be?

How do we realise the benefits of scale?

What capabilities will we need?

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@robertvarnam

Clarity

Commitment

Agility

Alignment

Priorities

Partnerships

4 400

We need the best of both worlds

What is the ideal size?

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@robertvarnam

STP footprint: 300k-2mWorkforce & infrastructure planningLarge scale service reconfigurationMajor partnerships & shifts in priority

MCP: 100-350kOrganisational infrastructure & governanceSpecialist staff & servicesEmployment & career developmentModel design (population management, care models)Strategic partnerships

Hub/Home: 30-60kAcute careLocality-tailored servicesShared MDTPlace of ‘belonging’

Core team: 3-4kCoordinated, complex multidisciplinary careContinuity

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@robertvarnam

Where are we heading?

What size should we be?

How do we realise the benefits of scale?

What capabilities will we need?

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@robertvarnam

Where are we heading?

What size should we be?

How do we realise the benefits of scale?

What capabilities will we need?

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@robertvarnam

Working at scale: Opportunities for practices

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#GPforwardview

Staff pooling• nurses, reception & clerical staff, sessional GPs

Overflow support• phone consultations• access hub (phone +/- face-to-face)• home visiting

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#GPforwardview

Purchasing• Indemnity• Supplies• Utilities

Shared functions• Policies & procedures• Procurement• Correspondence management• IM&T (eg support & maintenance, intranet, web, social media)

Specialist functions• HR• Finance• Clinical governance• Business intelligence

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#GPforwardview

Planning• Workforce• Infrastructure development• Service reconfiguration• Public health

Provision• Acute care• Community pharmacy• Dentistry• Optometry• Social care• Housing• Welfare• Voluntary sector

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#GPforwardview

Traditional healthcare roles• Pharmacists• Specialist nurses• Physiotherapists• MH therapists• Paramedics

Wellbeing workers• Social workers• Care navigators• Health trainers & coaches• Welfare advisors

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#GPforwardview

QI expertise

Analytics• Population health analytics• Priority setting• Benchmarking• Realtime measurement

Project management

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#GPforwardview

HR

CPD

Career development• Leadership• Mentoring• Service improvement• Research

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@robertvarnam

Where are we heading?

What size should we be?

How do we realise the benefits of scale?

What capabilities will we need?

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@robertvarnam

Where are we heading?

What size should we be?

How do we realise the benefits of scale?

What capabilities will we need?

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@robertvarnam

Leadership

Creating shared purpose

Strategic planning &

partnerships

Leading through change

Being a leader

Improvement

Patients as partners

Process design

Using data for improvement

Rapid cycle change

Business

Team leadership

Operations management

H R

I T

At-scale working

Governance

Contracts

Workforce

Business intelligence

Capabilities for the future

Interdependent capabilities for leaders & organisations

Robert Varnam
Ops & team management
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#TimeforCarewww.england.nhs.uk/gp

Local Time for Care programmes• Bespoke 9-12 month

programme to support a group of practices to implement innovations that release time for care.

• Training for reception and clerical staff, for active signposting and document management (£45m over 5 years).

• Funding towards purchasing online consultation systems (£45m over 4 years, from 2017).

• CCG transformational support (£171m over 2 years, from 2017).

General Practice Improvement Leaders• At least 400 free places a

year for three years.

• Skills and confidence in designing and implementing improvements within the practice rapidly and sustainably.

• RCGP Supporting Federations Network and NHS Collaborate (NAPC & NHS Alliance) for leaders of at-scale primary care.

• Funding facilitated peer networking for practice managers of all 7,800 practices, with support to develop professional skills.

• 24 regional GPFV roadshows• 30 local High Impact Actions

showcase events• Web resources (60 and

growing)• Fortnightly webinars• Network of champions

10 High Impact Actions to release time for care

www.england.nhs.uk/gp

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@robertvarnam

Where are we heading?

What size should we be?

How do we realise the benefits of scale?

What capabilities will we need?

Implications for me?

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#GPforwardview

Opportunities for sharing and development

James DillonPractice Index

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#GPforwardview

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#GPforwardview

Your personal development• find someone you don't know

• share:

• best things you've done to develop yourself

• things you're most interested to do in future

• write things down!

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#GPforwardview

Next steps

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#GPforwardview

www.england.nhs.uk/gp

[email protected]