Bromley Primary Care Needs Assessment – Findings Dr Agnes Marossy Dr Agnes Marossy Consultant in Public Health
PRIMARY CARE NEEDS ASSESSMENT The aim of the Primary Care Needs PCNA CLINICAL Assessment is to describe both the need for STEERING REFERENCE primary care and the needs of those GROUP GROUP delivering primary care in order to inform the development of a sustainable model of primary care in Bromley. WORKLOAD EVIDENCE ANALYSIS WORKFORCE QOF & HES SURVEY DATA POPULATION ENGAGEMENT DATA
PRIMARY CARE NEEDS ASSESSMENT PCNA Steering Group � GP Clinical Directors PCNA CLINICAL � Bromley GP Alliance STEERING REFERENCE � CCG Primary Care Team GROUP GROUP � CCG Nurse Lead � Director of Organisational Development WORKLOAD EVIDENCE ANALYSIS WORKFORCE QOF & HES SURVEY DATA POPULATION ENGAGEMENT DATA
PRIMARY CARE NEEDS ASSESSMENT PCNA CLINICAL Clinical Reference Group STEERING REFERENCE � GPs (Partners, Salaried, Locums, Trainee) GROUP GROUP � Practice Nurses � Practice Managers WORKLOAD EVIDENCE ANALYSIS WORKFORCE QOF & HES SURVEY DATA POPULATION ENGAGEMENT DATA
ENGAGEMENT CCG Membership Practice Visits (42/45) Practice Nurse Forum Practice Managers’ Forum Locum/Salaried GP Group Public Engagement BME Groups Learning Disabilities Mental Health Mental Health Sensory Impairment Long Term Conditions WORKLOAD EVIDENCE ANALYSIS WORKFORCE QOF & HES SURVEY DATA POPULATION ENGAGEMENT DATA
PUBLIC ENGAGEMENT � Continuity � Skill Mix � Vulnerable Groups � Consultation Length WORKLOAD EVIDENCE ANALYSIS WORKFORCE QOF & HES SURVEY DATA POPULATION ENGAGEMENT DATA
PRACTICE VISIT QUESTIONS Population Access Workforce Integration & Coordination Complex Multimorbid Patients Shift of Care Closer to Home Resilience Resilience Models of Care Integrated Care Networks WORKLOAD EVIDENCE ANALYSIS WORKFORCE QOF & HES SURVEY DATA POPULATION ENGAGEMENT DATA
DISEASE BURDEN POPULATION HEALTH OUTCOMES PRIMARY CARE NEEDS WORKFORCE WORKFORCE WORKLOAD WORKLOAD ASSESSMENT ASSESSMENT RESILIENCE ACCESS MODELS OF CARE HOME
WORKFORCE CAPACITY “In order for Bromley to reach the same ratio as London, an additional 2.7 WTE GPs are needed in Bromley, and to reach the same ratio as England, an additional 13.4 WTE GPs are needed.” GPs “Bromley has a higher nurse to patient ratio than London, but an additional 18 WTE nurses (of all types) are needed to reach the same ratio as England.” the same ratio as England.” PNs In order to keep up with population growth, we need 1.5 additional GPs per year in Bromley. NEW ROLES NON CLINICAL STAFF
CAPACITY VIEWS ON PARTNERSHIP VIEWS ON LOCUMS The annual workforce survey in Bromley The annual workforce survey in Bromley shows that we lost 1.85 WTE GPs last year. BACK
CAPACITY VIEWS ON PARTNERSHIP VIEWS ON LOCUMS BACK
� � Salaried GPs Too Few Applicants Difficulty in retention � � Practices don’t know how to Excessive workload access the trainee cohort Causes GPs to resign � Competition from posts at Practices protect salaried GPs access hubs and UCC from workload to retain them. � High indemnity fees � � Salaried GPs not willing to be on call Salaried GPs not willing to be on call � Only want to work 4 to 6 sessions per week � Want a mentor Don’t develop the full range of GP skills
CAPACITY VIEWS ON PARTNERSHIP VIEWS ON LOCUMS BACK
CAPACITY NURSE RECRUITMENT The annual workforce survey in Bromley shows that we lost 1.13 WTE ANPs whilst gaining 2.95 WTE PNs relating to an overall increase of 1.83 WTE PNs relating to an overall increase of 1.83 WTE Nurses last year. Alongside that there was a loss of 1.37 WTE HCAs BACK
CAPACITY NURSE RECRUITMENT ISSUES INNOVATIONS Retirement of longstanding experienced Nurses as mentors nurses Small pool of practice nurses In house training of nurses Hospital nurses not aware of practice Student nurse placements in practices nursing Terms & Conditions not standardised Use of a training contract with and less attractive than in secondary commitment for nurse to stay in care. practice Lack of training courses Higher rates of pay BACK
WORKFORCE Key Issues: � Insufficient number of GPs and nurses � Lack of skill mix � Competition between local services for GPs and � Competition between local services for GPs and nurses � Undesirable workload and work life balance OVERWHELMING WORKLOAD
WORKLOAD Much is spoken about General Practice workload, chiefly about it increasing and becoming unmanageable, but what exactly are we talking about? Under the GP Contract, GPs must provide a service to manage a registered list of patients. This includes manage a registered list of patients. This includes consultation, treatment, onward referral for investigation and extended primary care services such as prevention, screening, immunisations and some diagnostic services. GPs also help to ensure effective coordination of care for their patients with other NHS services, social care and health services outside the NHS.
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WORKFORCE We are at the point where the issues of INSUFFICENT CAPACITY AND AND OVERWHELMING WORKLOAD are creating an unsustainable future for Primary Care in Bromley and we therefore need to do something transformational…
OPTIONS STATUS QUO OPERATING AT SCALE MERGERS/TAKEOVERS COLLABORATION - Take a long - Retain time Partnerships - Often fail on - Retain premises premises Premises (at Premises (at issues least in the short term) Who will be PREMISES LAST MAN - Financial Considerations/ Ownership STANDING? - Exit Strategy - ?Attractiveness to new partners - Current state/capacity
THE TRADITIONAL MODEL… GP PARTNER PHYSICIAN PRACTICE ASSOCIATE ASSOCIATE SALARIED & LOCUM GPs SALARIED & LOCUM GPs MANAGER CLINICAL ADVANCED NURSE PHARMACIST PRACTITIONER RECEPTIONIST/ MEDICAL OTHER ADMIN ASSISTANT PRACTICE NURSE ROLES HCA
THE NEW MODEL GP E MANAGER NAVIGATOR PHYSICIAN Snr CLINICAL ANP PRACTICE M ASSOCIATE PHARMACIST CARE NA CLINICAL HEALTH COACH PRACTICE NURSE PHARMACIST MEDICAL ASSISTANT HCA RECEPTIONIST MEDICAL SECRETARY TRAINING & SUPPORT
RESOURCES : RESOURCES : BROMLEY NEW MODEL £££ and people Based on 30-50,000 patients CLINICAL LEADERSHIP TARGETED ACUTE LTCs CONSULTATIONS CONSULTATIONS UNIVERSAL ONLINE ONLINE SERVICES Active Signposting in Active Signposting in practices and online CPs/PNs/HCAs/Health Immunisation CARE HOME S Coaches Screening � Monitoring STREAMING NHS Health Checks � Review LD HCs HOUSEBOUN � Std. Management SMI HCs � Medication Review MAJOR MINOR Lifestyle Management E SERVICE OUND Sexual Health Sexual Health ANP ANP Contraception Paramedic GROUP GROUP Dressings PA CONSULTATIONS DIAGNOSTIC REMOTE DIGITAL MONITORING SERVICES: Phlebotomy ECG GP Ambulatory BP CARE NAVIGATOR/HEALTH COACH/MEDICAL ASSISTANT QUALITY ASSURANCE GP and Nurse ROTATIONAL AND Admin shared across PORTFOLIO posts, encompassing QOF across the network or across whole area the network utilising Access Hubs, community, general WORKLOAD FILTERING practices and UCC
“Refocusing of the GP role as expert medical generalists with a focus on undifferentiated presentation, complex care and whole system quality improvement and clinical leadership” CLINICAL LEADERSHIP QUALITY ASSURANCE GP / PRIMARY CARE CONSULTANT PARTNERS SALARIED LOCUM GP RETIREE PROGRAMME VERSATILE GP PORTFOLIO & Bromley network of locums ROTATIONAL POSTS Access to training & support MENTORING NEW GPs Online platform for matching & These roles will include practice work Different ways of working (e.g. as well as NEW SKILL MIX remote) Access Hubs/UCC/OOH. Clearly defined packages/contracts Thereby reducing competition to recruit into these roles CREATING SUSTAINABILITY
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