Professional Documents
Culture Documents
GPFV
GPFV
FORWARD VIEW
APRIL 2016
#GPforwardview
General Practice Forward View
Version number: 1
Classification: Official
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Contents
Chapter 1: Investment 10
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Introduction
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Simon Stevens
Chief Executive, NHS England
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But this is a challenge when it Teams need support and We will also develop different
is difficult to find time to look space if they are to adopt new ways of managing clinical
up from the day job. For GPs to ways of working. This is why demand. In addition to increasing
believe in a better future we must NHS England plans to invest self-care, use of different
first start to feel the impact of in a national development triage methods and a broader
changes now. Some of the new programme at individual, practice workforce sharing the burden,
measures within this document and network or federation we also need to grow capacity
are specifically designed to level. I have been struck by how through a network of locality
provide immediate relief to positively received the recent NHS primary care access Hubs (as seen
existing pressures. We need to England and BMA roadshows in the GP Access Fund areas) and
tackle issues such as irrelevant on releasing capacity have been. increase clinical personnel behind
communications, duplicate However, this should be viewed services such as 111, for example,
reporting, unwieldy payment as the start of a journey in nurses, pharmacists and dentists.
systems and streamline oversight supporting practices to build the
and regulation. capacity and capabilities required
within our teams. We must and
will go much further.
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Chapter 1: Investment
We will accelerate funding of primary care
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1
As part of agreed devolution arrangements, Greater Manchester has been allocated a
transformation fund which includes an appropriate share of NHS England funding for
primary medical care initiatives. It will be for Greater Manchester to determine how it
is spent in the local area.
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Many believe that the Carr-Hill Tackling rising costs of working with the medical
formula is now out of date and indemnity defence organisations and
needs to be revised to reflect Indemnity costs have risen in the indemnity insurers to meet
changes in the population NHS in England significantly in the needs of new ways of
and the impact of this on recent years. This is the result of delivering care. For example,
comparative workload. NHS the rising number of claims, and through products that treat
England is working with the the rising level of awards made the delivery of services across
BMA to review the Carr-Hill by the courts, with the cost of practices outside of core hours
formula to specifically examine care packages doubling every (with shared access to patient
the impact of deprivation, age seven years. This is despite the records) as similar to in-hours
and other factors that influence fact that on objective measures, working, rather than charging
practice workload. This work the quality and safety of care the out of hours rate. This is
will be concluded in the summer provided by GPs has never been in recognition of access to the
of 2016, and form the basis of higher. GPs tell us that these patient record.
discussion with the BMA about costs are distorting decisions
changes that might be needed. about whether to remain in work Some GPs have called for
(particularly for those choosing to general practice to have Crown
A minority of practices are yet work part-time), whether to work indemnity. This would mean it is
to undergo their PMS contract in GP out of hours and urgent not possible to sue for damages
reviews. We are committed care services for non NHS trust and that the small minority of
to ensuring this process is providers, and whether to deploy patients who had suffered harm
completed in the interest of the wider clinical workforce as a result of clinical negligence
equity across all practices. (where costs for nurse indemnity would not have recourse to any
However, in the interests of can be the equivalent of medical financial compensation. We do
stability, these changes are being indemnity). not believe that this is the intent
phased over a minimum of four of the profession, and this form
years, ensuring there is a water NHS England has taken initial of immunity does not apply to
tight reinvestment plan for all steps to alleviate these pressures other health services.
savings in local general practices, through:
and engaging in individual Rather, we believe that the
conversations with practices that the establishment in 2014/15 shared aim of all those working
are particularly challenged. and 2015/16 of a 2.5 million in the NHS is to bring down
winter indemnity scheme to the overall costs associated
CCG plans for reinvestment help with the costs of those with negligence claims in an
must be published before the working out of hours appropriate fashion, and ensure
full impact of Personal Medical taking into account increases in that the way that those costs are
Services (PMS) reviews are indemnity costs, amongst other borne does not dis-incentivise
implemented for individual factors, in agreeing funding for excellent clinical staff from
practices. the 2016/17 GP contract. working in the NHS or restrict
access to justice.
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The Department of Health will The Department of Health In principle, GPs should be no
be consulting shortly on the and NHS England will instead more exposed to the rising costs
options for introducing a Fixed bring forward proposals in July of indemnity than our hospital
Recoverable Cost scheme to cap 2016 for discussion with the doctors, and any solution will
the level of recoverable costs profession, medical defence need to address this.
for claimant lawyers on clinical organisations, the commercial
negligence claims. The aim is insurance industry and the NHS Taken together, this represents a
to make the cost of claimant Litigation Authority. This will significant programme of work
lawyers more proportionate to consider potential solutions, to reform indemnity in general
damages and defence costs. including considering: practice, addressing some short-
term pressures whilst looking to
We and the Department of how personal costs of bring down the overall costs to
Health are also committed to indemnity and clinical insurance the system.
reviewing the way in which can be contained, provided
costs are funded. Any changes certain clinical governance
would have a bearing on standards are met with the
historical claims and handling objective of reducing the
of past liabilities. This is overall costs to the individual;
complex with the potential to reducing indemnity costs
create unintended financial for individuals in particular
consequences if mishandled. circumstances, such as GPs
The Clinical Negligence Scheme who wish to remain in the
for Trusts (CNST) is a risk-pooling workforce on a part-time basis
arrangement for trusts, and past a certain age; and
requires every organisation to enable new models of
contribute funds. The rising costs care such as Multispeciality
of CNST has been an issue for Community Providers (MCPs)
providers in other sectors, and to to take on corporate indemnity,
date, we have not seen evidence freeing up individuals working
that access to CNST would bring in those new models from the
down the costs for practice burden of personal indemnity
partnerships. There would be costs.
significant implications for the
treatment of historical claims, for
the insurance market in general,
and it might increase costs to
practices. So this is not a simple
solution.
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Chapter 2: Workforce
We will expand and support GPs and
wider primary care staffing
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Work to date Last year, NHS England, HEE, Through the 10 point action plan,
The Primary Care Workforce Royal College of General together we have:
Commission, set up by HEE and Practitioners (RCGP) and the
chaired by Professor Martin General Practitioners Committee delivered a marketing campaign
Roland, called for a broader (GPC) developed an initial 10 to encourage foundation year
range of staff to be involved in point action plan Building 2 doctors who are applying
providing care. Their report, The the Workforce a new Deal for for specialty training to choose
future of primary care creating General Practice - to kick start general practice;
teams for tomorrow, set out initiatives to improve recruitment, launched a scheme to offer up
how we can better deploy the retention and return to practice. to 20,000 bursaries for 109
talents of the wider workforce to Now that there is significant new GP trainees to attract doctors
reduce the workload burden on investment for general practice, to parts of the country where
GPs, meet patients needs and we will be working together there have been consistent
to free GPs up to do what they and with other professional shortages of trainees;
do best. The report also set out bodies, such as the RCN, established new post-CCT
recommendations to increase Queens Nursing Institute, Royal fellowships to provide further
the role of nursing, advanced Pharmaceutical Society, National training opportunities in areas
clinical practitioners, medical Association of Primary Care and of poorest GP recruitment that
assistants, practice pharmacists NHS Clinical Commissioners encourage new CCT holders
and physician associates along to step up actions to grow the to work as GPs in those areas,
with stronger partnerships with workforce and stimulate a more whilst pursuing special interests
the voluntary sector and better diverse range of workforce and meeting local need such
use of technology. models within primary care. as urgent care and learning
disability care;
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We know we need to improve in the community and their Already, the new induction and
the number of medical school patients care. HEE has recruited refresher (returner) scheme has
graduates choosing to join and trained 35 campaign seen:
general practice. There is a strong ambassadors and advocates to
correlation between training support and promote national the end to multiple different
placements in general practice and regional activities including policies, with one single
and eventually working in general attendance at recruitment events national policy, supported by
practice. HEE is currently working and through social media. single website, a consistent
with the Medical Schools Council, set of written guidance to
higher education institutions, the We will supplement this applicants, and a new single
RCGP and the GPC to increase with a major international point of contact;
the profile of general practice recruitment drive, to attract up a significant increase in NHS
in medical schools and in their to 500 appropriately trained and England bursaries for the
curricula. qualified doctors and possibly period of time that the doctor
more - from overseas over the is in a supervised placement -
A working group, chaired by next five years. 2,300 per month up from a
Professor Valerie Wass OBE, will range of 0 to 500 per month
publish recommendations in Working with HEE we will previously depending on which
summer 2016 about recruitment evaluate its 20,000 bursary part of the country you are in;
and selection, finance and scheme to attract trainees into the end to requiring doctors
curriculum and the promotion of hard to fill areas and identify if working overseas to return to
general practice as a speciality. more needs to be done. England to start the application
process, with the ability to
The recommendations will HEE will roll out a total of 250 hold interviews now via Skype
improve the medical school post CCT fellowships by and sit initial assessments in
experience of general practice summer 2017 to offer wider countries all round the world;
through greater exposure to the and more varied training and
diverse and stimulating reality of opportunities in areas of poorest a review of the appropriate
general practice professionally GP recruitment. and relevant content of all
and personally. More graduates assessments, leading to a
will be encouraged to make a Retaining the current medical doubling of pass rates in the
positive choice of general practice workforce last nine months.
as a career. One of the strengths of general
practice as a career is its flexibility,
HEE and the RCGP will with the chance to work part-
continue to develop the current time or combine general practice
recruitment campaign to raise with work in other settings. We
the profile of general practice want to make it easier and more
as a career. The campaign attractive for GPs to return to
showcases the variety of different work in English general practice.
opportunities and the flexibility
of the specialty, as well as
the central role that GPs play
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introduce a Pharmacy
Integration Fund, worth 20
million in 2016/17 and rising by
a further 20 million each year,
to help further transform how
pharmacists, their teams and
community pharmacy work
as part of wider NHS services in
their area. Subject to a separate
consultation, our proposals
include better support for GP
practices, for care homes and
for urgent care for the use of
the fund;
Building the wider workforce pre-registration nurse invest in an extra 3000
The success of general practice placements and other measures mental health therapists to
in the future will also rely on to improve retention; be working in primary care by
the expansion of the wider extend the clinical pharmacists 2020 to support localities to
non-medical workforce programme with a new 112 expand the Improving Access to
including investment in nurses, million offer to enable Psychological Therapies (IAPT)
pharmacists, practice managers, every practice to access a programme;
administrative staff and the clinical pharmacist across provide 45 million extra
introduction of new roles such as a minimum population on funding nationally over five
physician associates and medical average of 30,000 - leading years so that every practice
assistants. to an extra 1,500 pharmacists in the country can help their
in general practice. Appetite reception and clerical staff
Our ambition is to use some of for the original pilot scheme play a greater role in care
the extra investment going into was high. We will need to navigation, signposting
general practice to support the learn more from the evaluation patients and handling clinical
employment of a minimum of but early indications suggest paperwork to free up GP
5,000 extra staff. clinical pharmacists may time. This builds on successful
have a role in streamlining pilots tested through the
To achieve this, at a national practice prescription processes, Prime Ministers GP Access
level, NHS England and HEE, over medicines optimisation, minor Fund schemes and vanguard
the next five years, will: ailments and long term sites where the majority of
conditions management. We clinical correspondence can be
invest an extra 15 million will roll this out further across managed through trained staff;
nationally in general the country over the next five pilot new medical assistant
practice nurse development, years, so that every practice can roles that help support doctors;
including support for return benefit. We will also open up pilot the role of primary care
to work schemes, improving the clinical pharmacist training physiotherapy services;
training capacity in general programme to practices that
practice for nurses, increases in have directly funded a clinical
the number of pharmacist;
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invest an extra 6 million The vanguard sites that are First, we will work with the
in practice manager testing new integrated models profession to introduce
development; of care and the GP Access Fund new measures entitling GPs
roll out the recently published schemes are already developing who want flexible working
HEE Community (District) many different ways of using the but who can commit to
and General Practice Nursing wider workforce, and proving working in a practice or an
Service Education and that this can be better for area for a period of time,
Career Framework and the patients and free up GP time. additional benefits relative to
accompanying HEE Education undertaking a rolling series
and Career Framework; A balanced GP workforce of short term locum roles. In
implement the Queens Nursing The model of independent other words, while continuing
Institute Voluntary Education contractor status and partnership to incentivise partnerships
and Practice Standards for has proved a valuable foundation and salaried commitments to
District and General Practice for general practice. Partners practices on the one hand,
Nursing; and provide leadership and continuity, we also want to create an
work with general practice to and in recent years this has been alternative to day-by-day or
ensure general practice nurses invaluable as general practice has week-by-week locuming for
have access to mentorship come under pressure. those at a point in their career
training. or family life who need more
We also recognise that a more flexibility.
This also needs to be flexible workforce better enables
supplemented at a local level, practices to secure short-term Second, NHS England will set
and for the first time - through support to cover sick leave, indicative rates for locums and
the Planning Guidance the NHS parental leave or transition will ask practices to indicate
locally has been asked to produce periods between leavers and in the annual e-declaration
plans to address workforce issues joiners. However many practices information where they are
in general practice. We will now report that a shift to reliance having to pay above those rates.
review these plans in the summer, on locums is undermining service This is to understand the scale
and identify any further actions continuity and stable team of the issues practices are facing
that need to be taken or ideas working. and help plan how we can target
that can be spread nationally to workforce support to areas facing
accelerate the growth, retention It is therefore in the interests of the greatest pressures.
and development of the general GPs and practices to improve the
practice workforce. relative attractiveness of partner Third, we envisage at scale
and salaried positions versus working in larger practice
a shift to a more unstable and groupings will create
short term workforce. opportunities to embed a more
locally focused team based
approach which incorporates
locums.
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Chapter 3: Workload
We will reduce practice burdens
and help release time
Workload was identified by the
2015 BMA survey as the single
biggest issue of concern to GPs
Support for general practice with the and their staff. Latest research,
management of demand, diversion published in the Lancet, suggests
that there has been an average
of unnecessary work, an overall increase in workload in general
reduction in bureaucracy and more practice of around 2.5 percent
integration with the wider health and a year since 2007/8, taking
care system including: account of both volume and
acuity. Whilst some of this rise
Major 30 million Releasing Time for Patients can be addressed by increasing
development programme to help release the workforce, we also want to
capacity within general practice (see also support practices in moderating
Chapter 5). demand and reforming how we
New standard contract measures for hospitals support and organise services.
to stop work shifting at the hospital/general
practice interface. The Primary Care Foundation
New four year 40 million practice resilience and NHS Alliance have identified
programme, starting in 2016. the changes that will have the
Move to maximum interval of five yearly CQC biggest impact in reducing
inspections for good and outstanding practices. bureaucracy and reshaping
Introduction of a simplified system across NHS demand. Their report, Making
England, CQC and GMC. Time in General Practice,
Streamlining of payment processes for practices, identified a number of practical,
and automation of common tasks. high-impact ways to remove
unnecessary pressures on general
practice and free up time for
patient care.
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Streamlining Care Quality What can practices expect New streamlined approach
Commission (CQC) practice nationally? to inspection for new care
oversight A reduction in inspections models and federated or
In October 2014, the Care Quality from CQC. This will apply once super-partnerships practices.
Commission (CQC) began to all GP practices have been CQC will continue to develop
inspect general practice services. inspected later this year. CQC the way it inspects to take
CQC ratings have, for the first will tailor its inspection activity, account of changes to the
time, provided a comprehensive taking a more risk-based way the sector is organised
assessment of the quality of care approach where it monitors and delivered, for example,
provided by practices. By April and acts on intelligence and through new models of care
2016, they had inspected over information. It will reduce the or federated practices with
a third of practices (35 percent) frequency of some inspections, a focus on the leadership,
and found that the vast majority so that it targets its resources governance and learning
(87 percent) are providing care on those practices where there culture of the provider, not
that is good or outstanding. is a risk of poor care. CQC will necessarily on inspecting every
agree with NHS England and single site.
The CQC will complete its first local CCGs a shared framework Funding for CQC. NHS
round of comprehensive to understand and report on England will discuss with the
inspections of all practices in quality. Practices rated good GPC how best to recognise
2016/17. CQC is consulting on and outstanding - currently any further fee increases
changes to its regulatory model the vast majority - will move and will ensure practices are
for its work thereafter. to a maximum interval appropriately compensated.
between inspections of five Improving and simplifying
These proposals will reduce the years, subject to the provision transparency of information
workload related to inspection of transparent data, available to about general practice.
for those practices that deliver CQC, NHS England and CCGs; A report from the Health
good or outstanding care, while and also to CQC remaining Foundation to the Department
encouraging improvement and assured that the quality of care of Health made a number of
ensuring a proportionate has not changed significantly recommendations on valid
approach that protects patients since the previous inspection. quality indicators for general
from the risks of poor care. Where CQC has concerns, it practice. A set of key sentinel
may revisit sooner. indicators will therefore be
Another issue related to CQC has published on My NHS in July
been that of the fees increase for 2016.
registration. In recognition of this,
NHS England agreed with the
GPC to reflect these costs in the
2016/17 GP contract settlement
to address this cost pressure for
practices.
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A major programme is also We will continue to support the over time. This will help practices
underway to ensure that by spread of good ideas. We will match their supply of
2020 all incoming clinical monitor the impact of work to appointments more closely
correspondence from other NHS reduce pressure on practices, and to demand. We will make it
providers is electronic and coded. we want to empower practices available for every practice from
This will reduce practice to also do this. We are therefore 2017/18.
workload and the risks of errors commissioning a new audit tool
in data entry, as well as improve to be available for all practices Mandatory training
the usefulness of incoming that will allow practices to Practices have told us that there
information and facilitate more identify ways they could reduce seems to have been a growth in
seamless patient care. appointment demand. This will mandatory training requirements
use the same methodology as for clinicians and other practice
Promoting best practice and in the Making Time in General staff. Examples include basic
monitoring improvements Practice report and allow life support, safeguarding,
We hosted a series of BMA and practices to compare themselves information governance, health
NHS England workshops to share with the national data. and safety, complaints handling,
evidence and examples with fire safety, fridge procedures
practices of the opportunities Practices in the GP Access Fund etc. Whilst it is easy to see the
to release staff capacity. 95- are about to begin testing of justification behind each one,
98 percent of practices that an automated appointment- the sum of them all creates a
attended reported that these measuring interface to give them significant burden on staff, and
gave them new practical ideas to detailed information about crowds out the more targeted
release staff time. their activity and how it varies training needs of individuals.
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NHS England will work with This will ensure that they Over the last year, the
relevant bodies to review and understand our vision for general Government has set up Fit for
reduce these requirements to practice and how they can and Work and will continue to
ensure a far more proportionate should support it. develop this approach. Fit for
approach is taken. We will also Work offers a free advice,
keep in mind the impact of Work and health assessment and case
appraisal and revalidation There is clear evidence that good management service for people
requirements in the analysis. quality work is good for health who are employed and off sick. It
and, conversely, being out of is intended to help GPs by
Support for more integration work has significant negative improving outcomes and
across the wider health and impacts on health. The Five Year reducing demands on them for fit
care system Forward View set out a vision for notes and detailed work-related
Social support the NHS to play a stronger role in advice.
Voluntary sector organisations prevention, including a focus on
can also play an important role in helping people at risk of falling out In addition, the Government
supporting the work of general of work. Easier access to health will now consider whether
practice. For example, local services for people in employment early dialogue on work and
models of social prescribing can should help individuals to seek health and the resulting
enable GPs to access practical, help at an early stage, and general sickness certification (fit note)
community-based support for practice staff have a role to play currently restricted to registered
their patients, including access to in recognising when early referral medical practitioners - could be
advice on employment, housing or treatment may be indicated for undertaken by other healthcare
and debt. Some areas have someone at risk of falling out of professionals.
developed call-off services for work.
specific groups such as carers. To promote the development of
This means that GPs will have social prescribing, a key measure
Local leadership greater access to treatment by which patients can benefit
We want all local Health and pathways, especially for from wider support, NHS England
Wellbeing Boards (HWBs) to conditions that have an impact are appointing a new National
recognise the centrality of primary on the ability to work for large Champion for Social Prescribing.
care in integrating their local numbers of people, such as
health and care systems and mental health conditions (IAPT)
the need to ensure access to all and musculoskeletal problems.
relevant support services. The
Department of Health will issue
guidance to Health and Wellbeing
Boards asking them to ensure
that joint health and wellbeing
strategies (JHWSs) include action
across health, social care, public
health and wider services to build
strong and effective relationships
with general practice services.
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CASE STUDIES
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Development of the
primary care estate
In 2015/16, NHS England began
Greater use of technology to enhance a multi million investment
patient care and experience, as well as programme to support primary
care and general practice make
streamlined practice processes: improvements in premises and in
technology, as part of the overall
Over 18 percent increase in allocations to CCGs
estates strategy for the local
for provision of IT services and technology for
NHS. This was backed by both
general practice.
capital and revenue funding,
45 million national programme to stimulate
and will continue as the Estates
uptake of online consultations systems for every
and Technology Transformation
practice.
Programme. Additional capital
Online access for patients to accredited clinical
investment will also be flowing
triage systems to help patients when they feel
into general practice beyond
unwell.
this programme, bringing the
Development of an approved Apps library to
estimated overall total of capital
support clinicians and patients.
investment in general practice
Actions to support the workload in practices
over the next five years to over
reduce, and achieve a paper-free NHS by 2020.
900 million.
Actions to support practices offer patients more
online self-care and self-management services.
NHS England is inviting CCGs to
Actions to make it easier for practices to work
put forward recommendations
collaboratively, including achievement of full
for investment in primary care
interoperability across IT systems.
infrastructure in future years by
Wi-Fi services in GP practices for staff and
the end of June 2016. CCGs
patients. Funding will be made available to
are developing commissioning
cover the hardware, implementation and service
plans designed to provide health
costs from April 2017.
care services for the future
A nationally accredited catalogue and buying
and producing Local Estates
framework for IT products and services,
Strategies, in conjunction with
supported by a network of local procurement
Community Health Partnerships
hubs offering advice and guidance.
and NHS Property Services.
Work with the supplier market to create a wider
and more innovative choice of digital services
for general practice.
Completion of the roll out of access to the
summary care record to community pharmacy,
by March 2017.
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In addition, the Department What does this mean for Core GP information
of Health is working with practices? technology (IT) services
Community Health Partnerships Our ambition is to support NHS England is introducing
to mobilise the potential of public the adoption and design of a greater range of core
and private sector partnerships in technology which: requirements for technology
the development of the primary services to be provided by
care estate, building on the LIFT enables self-care and self- vendors to general practice
programme which covers almost management for patients; through the CCG-controlled GPIT
half the country. helps to reduce workload in budget. During 2016/17, services
practices; should include:
Investment in better helps practices who want to
technology work together to operate at the ability to access digital
New technology is already scale; and patient records both inside and
playing an important role in supports greater efficiency outside the practice premises,
improving patient care. Practices across the whole system. for example, on home visits;
round the country are using specialist support including
technology to move from paper We will do this in three ways: services for information
to digital records, offering governance, IT and cyber
online transactions including through extra investment security, data quality, clinical
online registration, appointment with an increase of over 18 system training and
booking, ordering of repeat percent going into allocations optimisation, clinical (systems)
prescriptions and viewing of for CCGs for the provision safety and annual practice IT
medical records. Some practices of IT and technology services review;
have gone far beyond these more for general practice, and a outbound electronic messaging
transactional interactions, and we specific 45 million multi-year (for example, SMS) from the
now need to support much more programme to support the practice for direct individual
widespread adoption of their uptake on online consultation patient clinical communication;
innovations. systems; the ability for patients to
through setting new core transact with the practice
A growing number of practices requirements making it through online appointment
are introducing new apps and clear what general practice management, repeat
web portals that help patients should be able to expect from prescription requests and access
assess and manage their own IT services, and creating a new to their detailed record and test
health risks. These provide framework to assess progress results, with the aim that at
information, symptom checkers the Digital Primary Care
least 10 percent of patients will
and sign posting to alternate Maturity Index; and
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CASE STUDY
CASE STUDY
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CASE STUDY
Individuals with long term conditions who previously might have attended A&E at
the weekend and been admitted to hospital are often now able to avoid a crisis by
sending a quick message to their doctor.
Modalitys call centre handles up to 1,300 calls per day, with most patients now
given advice or treatment without visiting a surgery. Around 90 percent of both
Skype consultations and call-backs by GP partners are closed without a surgery visit.
Salaried GPs and advanced nurse practitioners close nearly half of their telephone
consultations in the same way.
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CASE STUDY
A roving doctor service, designed to see patients within two hours of contacting
their GP, has helped reduce the number of patients needing emergency care. The
service, triaged by an on-call GP, is for patients who need a home visit but are not
at the point of needing hospital care. This model of service delivery, when in full
operation, is expected to create over 90,000 additional appointments per year, with
no patient in the area being more than three miles from a hub.
Other future improvements will include a click and collect prescribing service for
prescriptions and a lifestyle app to help GPs gain a holistic view of patient health.
Patients using the app will benefit from video consultations via the app, instant
messaging, a symptom checker, and feedback to/from patients.
Patients and clinicians who have used the service have provided positive feedback.
NHS Birmingham South and Central CCG has already commissioned two extra hubs,
in response to the success of My Healthcare so far. The CCG is now working to
expand the scheme to include all of its 55 member practices.
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We will now build on the lessons Does this mean every practice There will be some minimum
learned from the GP Access will have to open at evenings requirements and these will be
Fund schemes to support CCGs and weekends? published later in the year. They
in commissioning additional Delivering improved evening and will be tested with the current
capacity more consistently across weekend access is not about GP Access Fund sites during
the country, and in developing every GP or every practice nurse 2016/17, ahead of further roll
closer links with urgent care having to work seven days a out to more parts of the country
and out-of-hours services. Done week. Nor does it mean that in 2017/18 and years beyond.
well, this can lay the foundations every practice in the country How will it be rolled out?
for transforming the way in needs to be open seven days a Waves of increasing recurrent
which other general practice week. It will mean that groups funding will be made available
and community services can be of local practices and other each year, linked to CCG plans,
delivered collectively too. providers will be offered the to support the overall
funding and opportunity to improvements in general
We have set out below some collaborate to staff improved in practice. This phased increase
of the key questions raised. and out of hours services. in investment is designed to
match the planned growth in the
Who will be responsible for The provider could be a workforce.
commissioning and providing Federation if local GPs decide to
these services? express interest. It could also be What support will there be?
CCGs, working in conjunction a mix, for example, a Federation This document sets out a
with their urgent and emergency supplying additional capacity on range of national action to
care networks, will be responsible weekdays and Saturdays, with an provide support to practices
for commissioning these services existing urgent care organisation over the coming years, whilst
to expand capacity. CCGs will be providing pre-bookable GP the core funding for general
required to ensure that this extra appointments on a Sunday. practice increases. In addition,
investment in general practice NHS England will ask CCGs
dovetails with plans to develop Who decides what the service to provide 171 million of
a single point of contact to looks like? practice transformational
integrated urgent care and GP The balance of pre-bookable and support.
out of hours services, accessed same-day appointments, and
through a reformed 111 service. the level of capacity required on This is designed to be used to:
In addition, we will be seeking different days of the week, will
more joined-up services, for be up to individual commissioners stimulate development of at
instance, hubs hosting GP out of and schemes to determine in scale providers for extended
hours bases, community nursing light of patient demand in their access delivery;
teams and greater access to area and to ensure best value for stimulate implementation of
diagnostic services. CCGs will money. the 10 high impact changes
be required to meet minimum in order to free up GP time to
requirements before accessing care;
the additional funding. secure sustainability of general
practice to improve in-hours
access.
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CCGs have a responsibility to A new Multispeciality Armed with that larger budget
ensure a balanced financial Community Provider (MCP) and the flexibility to deploy it,
position, and will want to target contract the job of the MCP is to focus
investment in practice support Through the actions in this on better population health
where it can have most impact. document we aim to sustain, management, to suit different
renew and strengthen general groups of the population, and
What does this do to my practice. The MCP model is a get away from the treadmill
existing workload? fundamental element of this of the one size fits all 10
Offering a greater range plan, currently being developed minute consultation followed by
of evening and weekend by 14 MCP vanguards across the outpatient referral or prescription.
appointments, for example, country. This means:
through a local access hub,
should improve overall patient Today the range of services a stronger focus on population
flow and help reduce avoidable funded within general practice health, prevention, and
demand across the system. GP owes much to history rather than supporting and mobilising
Access Fund areas are already optimal working arrangements patients and communities;
reporting improvements and the for GPs or patients. more integrated urgent care as
intention is that all practices will part of a reformed urgent and
benefit from this reduction in The MCP model is about emergency care system;
workload as they are rolled out. creating a new clinical model integrated community based
and a new business model teams of GPs and physicians,
It is vital that alongside extending for the integrated provision nurses, pharmacists, therapists,
hours we also strengthen in- of primary and community with access to step up and
hours services. In addition to services, based on the GP down beds, in reach into
improving local appointment registered list, but fully hospitals, for example,
capacity, there will be investment integrating a wider range redesigning outpatients,
in online resources that will of services and including geriatric care, and diagnostics
help patients self-manage, relevant specialists wherever as part of extended community
for example, more self-help that is the best thing to based teams.
content on NHS Choices, do, irrespective of current
online consultations and 111 institutional arrangements. NHS England will shortly
Online, which is currently publish the MCP Care Model
in development. As part of At the heart of the MCP model, Framework and contract
the review into urgent and the provider ultimately holds a elements describing the emerging
emergency care there will also be single whole population budget model options in more detail.
a step change in the 111 phone for the full breadth of services Six local healthcare systems
service. it provides including primary are working intensively with us
medical and community services. to complete the design of the
contract, with the aim of going
live, on a voluntary basis, in
April 2017.
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Resilience: a growing number National three year The main components proposed
of federations are helping Releasing Time for Patients for the programme are:
practices improve their development programme
resilience through sharing back For many years, the improvement Innovation spread: a
office functions, developing support offered to other parts national programme to gather
business intelligence systems of the NHS such as the acute and disseminate successful
and creating shared pools of sector has not been matched by examples and measure impact.
staff. equivalent support for primary This will include support on
System partnerships: care. implementation of the Ten High
establishing a shared identity Impact Actions, and a specific
across practices makes it easier In 2014/15, NHS England focus on addressing inequalities
for primary care to have a established an initial development in the experience of accessing
larger voice in the local health programme for general practice, services, where there are
and care system, and facilitates offering support to practices that national trends.
partnership working with other were part of the GP Access Fund Service redesign: locally
providers. This is key to creating schemes to enable them to hosted action learning
new models of care for the work together, and to introduce programmes with expert
future. new ways of delivering care, input, supporting practices
such as telephone consultations and federations to implement
These are welcome developments or different use of other high impact innovations which
we wish to see grow in coming professionals in the general release capacity and improve
years. We will share these practice workforce. The feedback patient care.
examples more widely to ensure on this programme from GPs has Capability building:
that all emerging groups are able been positive, with 96 percent investment and practical
to benefit from opportunities to reporting that it had a large support to build change
expand services, stabilise practice impact on their ability to lead leadership capabilities in
income and realise the benefits rapid service redesign. practices and federations,
that working at scale offers. enabling providers to improve
We want to scale up the offer of quality, introduce care
We will continue to ensure that support to practices to accelerate innovations and establish new
national investment programmes, change. So in 2016/17 we arrangements for the future.
such as on access and new care will establish a new national
models, support the development development programme,
of at-scale infrastructure. available to all practices, with an
investment of 30 million over
three years.
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Stimulating local support CCGs who have already been Support, consultancy and
CCGs have a legal responsibility involved in provider development capability-building for general
to improve the quality of care are finding that three things practices are available from
in general practice. A growing are most effective: creating a range of regional and local
number are also focusing on space for practices to meet bodies. We will work with them
the need for significant provider and plan together, through to ensure that practices and
developments in order to meet funding backfill; providing federations have ready access to
the changing needs of their expert facilitation to make rapid credible, relevant and high quality
population and address current progress on reviewing options support for the full range of their
pressures. and creating improvement plans; development needs. We will
and focusing development develop frameworks to enable
CCGs will need to strengthen on improving care and ways practices to choose the support
arrangements for protected of working before addressing that is right for them.
learning time and backfill to questions of organisational
enable GPs time and space for form. CCGs are encouraged to This national development
development. Many are already ensure their Sustainability and programme will be designed
providing significant support Transformation Plans contain in collaboration with practices,
for practices and federations to details of their approach and professional leaders and
redesign care and build more plans for provider development. improvement experts. Further
sustainable organisations for the NHS England will review these in details, including how federations
future, but the current provision summer 2016. and practices can join, will be
of support is too patchy. We wish published in the summer.
all practices in England to benefit
from locally funded development.
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CASE STUDIES
Of 5,500 patients referred to the service in its first six weeks of operation, 3,350 (61
percent) were able to have their needs met on the telephone. The remaining 2,150
patients attended a face-to-face SDAS consultation. The face-to-face consultation service
is staffed by GPs, emergency nurse practitioners, paediatric nurses and practice nurses.
The initiative has contributed to greater GP availability in the practices; better working
conditions for practice staff; longer appointments available for patients with complex
needs; and reduced waiting time for routine appointments.
Both the weekday telephone triage and pre-bookable weekend services are provided at
a central site at Morecambe Health Centre, chosen because of its co-location with the
same day service (SDS) and the out of hours (OOH) service.
The service is staffed by existing GPs from the participating practices and is
supplemented by an Advanced Nurse Practitioner (ANP) at weekends. Since the 8am
8pm service has been operational, an additional 31 hours of non-core GP time has
been made available per week to provide both access to GP triage calls or face to face
appointments at weekends. Over this period, an additional 16,400 appointments have
been made available of which 79 percent were by telephone. Over the Easter bank
holiday weekend, over 400 calls were received by the service. Of these, 300 were triaged
and resolved and only 5 percent were required to be booked in elsewhere in the system
(SDS or their own GP practice for example).
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Conclusion
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Get in touch:
www.england.nhs.uk/gp
@NHSEngland
england.gpfv@nhs.net