GP Cluster 14 December 2017 Healthier. Stronger. Together
PARKING - IMPORTANT Whilst delegates are given free parking whilst attending an event at Somerdale, each individual is responsible for ensuring that their details are input completely and correctly to avoid incurring a parking ticket.
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Improving Access James Childs-Evans Senior Commissioning Manager (Primary Care) Healthier. Stronger. Together
Improving Access: How we got here June 2017: CCG / NHSE, Cluster meeting / Your Health Your Voice engagement sessions Summer 2017: Review of feedback within CCG / NHSE • BEMS update to August Cluster meeting summarising feedback so far Autumn 2017: • Further engagement session at October Cluster meeting • BEMS engagement with localities • NHSE GPFV Time for Care (Dr Robert Varnham) session 14 Nov Still awaiting procurement guidance – APMS suggested by NHSE as preferred contracting route Extended Hours expected to remain for 2018/19, changes possible in 2019/20
Improving Access: How we got here (2) • Lots of shared local ideas over the types of services, staff models and geographical footprints • NHSE , LMC views over what is acceptable / required However, a shared series of risks / concerns • Limited evidence for additional demand as outlined in core requirements (e.g. evenings and weekends) • Divert / distract from existing schemes with similar aims (Extended Hours / Winter Pressures / Early Home Visiting) • Destabilising Integrated Urgent Care mobilising for May 2018, drawing from similar staffing pool • Confusion for public and health / social care community staff over navigating / accessing appropriate services
Improving Access: How we got here (3) Our interpretation of requirements and expectations of successful scheme: • Small number of schemes, rather than 26 offerings (use natural geographies where possible) • Additional access funding is not just delivering additional, face to face appointments with a GP (use of other staff groups) • Model should allow all practices to book into additional appointments (reduce unused appts. / improve access) • Allow local provider(s) to access patient record for appointment (patient safety / reduce potential indemnity costs)
Proposal for BaNES CCG Propose a simplified model (GP / Nurse / HCA) to NHSE for approval: • Located (initially) in x2 GP practices, in and out of Bath City • 6-9pm Mon - Fri, 10-2pm Sat and Sun • Phased in from end of Q2 2018/19 (Saturdays only) end Q3 (Saturdays and Sundays), end Q4 (Weekends / Weekday Evenings) • Not (initially) located at UCC or Paulton • Early Home Visiting / Winter Pressures to be referenced in narrative to NHSE rather than hours calculations Why this approach?
Proposal for BaNES CCG (2) • Already meets NHSE requirements (similar to Windsor model) • Lower impact change in BaNES to minimise effects on existing resilience • GP practice locations will already be regularly open in evenings / and or weekends as part of Extended Hours provision • Limit confusion during mobilisation with Integrated Urgent Care – particularly during winter 2018/19 • Opportunity to clarify actual demand in primary care Provide future flexibility and contingency funding to: • Make further case to NHSE for extending existing / different provision based on actual demand data / experience • Increase, reduce or change locations in BaNES • Provide alternative services within existing footprints
Proposal for BaNES CCG (3) Funding: 2018/19 £636k £100k for x2 hubs:10% end Q2, 30% end Q3, 100% from 31/3/19 £430k Early Home Visiting £100k Contingency (IT / Staffing) Total: £630K (all amounts tbc) Funding: 2019/20 £1.2m £400k for x2 hubs (full year effect) £430k Early Home Visiting £370K Contingency (e.g. IT / Staffing / Winter Pressures, Hub / Service changes) Total: £1.2m (all amounts tbc)
Proposal for BaNES CCG – NHSE Submission • Provider(s) - 2 GP practice based hubs – In / outside Bath • GP, Nurse / other HP & HCA Model – GP appt available at all times Core Hours Mon - Fri Evening Hours Mon - Fri Weekend Hours 6-6.30pm 6.30-9pm 10-2pm Total Hub 1 Mon Tue Wed Thu Fri Total Mon Tue Wed Thu Fri Total Sat Sun Total hours Opening Hours 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 GP 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 PN/Physio/Other tbc 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 HCA 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 Hub 1 staff hours 1.5 1.5 1.5 1.5 1.5 7.5 7.5 7.5 7.5 7.5 7.5 37.5 12 12 24 69 Core Hours Mon - Fri Evening Hours Mon - Fri Weekend Hours 6-6.30pm 6.30-9pm 10-2pm Total Hub 2 Mon Tue Wed Thu Fri Total Mon Tue Wed Thu Fri Total Sat Sun Total hours Opening Hours 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 GP 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 PN/Physio/Other tbc 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 HCA 0.5 0.5 0.5 0.5 0.5 2.5 2.5 2.5 2.5 2.5 2.5 12.5 4 4 8 23 Hub 2 staff hours 1.5 1.5 1.5 1.5 1.5 7.5 7.5 7.5 7.5 7.5 7.5 37.5 12 12 24 69 Total Hours 3 3 3 3 3 15 15 15 15 15 15 75 24 24 48 138
Proposal for BaNES CCG • Provider(s) - 2 GP Practice based hubs – In / outside Bath • GP, Nurse / other HP & HCA Model – GP appt available at all times Core Requirement Delivery Model Met ✓ minimum additional 30 minutes consultation capacity per 1000 200,000 pop, 101 consultation hours required population, rising to 45 minutes per 1000 population 138 hours consultation capacity delivered 41 mins per 1000 population ✓ weekday provision of access to pre-bookable and same day 6pm - 9pm weekdays - 2 hubs appointments to general practice services in evenings (after 6:30pm) – to provide an additional 1.5 hours a day weekend provision of access to pre-bookable and same day 10am - 2pm sat/sun - 2 hubs ✓ appointments on both Saturdays and Sundays to meet local population needs ✓ provide robust evidence, based on utilisation rates, for the proposed Facilities open 46 hours per week disposition of services throughout the week (23 hours per hub) Consultation hours delivered: 11% core 54% in Evenings 35% at Weekends • Narrative to note Early Home Visiting and Winter Pressures as part of plan
Breakout Session The Model • Comments or questions? • Are there any amendments you would like to see? Main Room Breakout Area Bath Sulis Chew Keynsham Bath Aqua Norton Radstock
Dudley Visit on 30 th November GP Cluster 14 th December 2017 Healthier. Stronger. Together
Why did we go? Opportunity to learn more about Dudley’s: • multi-specialty community provider (MCP) model, inc practice integration • contractual & procurement framework • MDTs and how they work at practice & locality level • overarching outcomes framework & QoF replacement • GP leadership • pharmacy point of delivery model
About Dudley • Selected to join NHS England’s Vanguard programme in 2015 • 315,000 population • Co-terminus with Borough Council • One main acute provider – 80% of activity • 177 contracts, £445m total budget • Currently 79% activity based, 18% fixed budget, 3% outcome based • Drivers for change – demand & financial challenges (LTCs and frailty) and primary care resilience
Primary care • 45 practices, soon to be 44 – many small with sustainability issues • Moved from PMS to GMS • £50m primary prescribing budget • Outcome based contract replacing QoF , LES’s & DES’s with focus on holistic assessment & person centred care planning • Offered as a voluntary opt out to QoF • One system (EMIS) – training, education & IT provided in-house by CCG, inc template writers • Piloting pharmacy POD
Services in scope • All community services – adult, children, physical health, mental health, learning disability • Inpatient LD/MH • Public health commissioned services • Urgent Care Centre and GP Out of Hours • Out patient services – predominantly medical specialties and for long term conditions • Emergency admissions associated with falls, from care homes and ambulatory care sensitive conditions • LCSs – discretionary commissioning • Primary medical services
Laying the tracks… • Primary care at the heart of the model supported by a MDT in each practice • Population need driving model of care • 15 year population health outcomes based contract – new legal entity • Three options for practices in MCP • One capitated budget (£234m plus £40m for GMS) – 55% fixed, 38% activity & 6% on outcomes • Outcomes framework for Dudley – four domains • Now in competitive dialogue phase with one bidder
Cultures working in partnership
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