Put on Your Oxygen Mask: Take Charge of Your Life, Learning and Prosperity Hemant Patel, NEL LPC, Secretary INDEPENDENTS Evolving Together
Video: Changes
The NHS Health and Wellbeing Framework • The NHS needs staff that are well and at work to deliver effective, quality care for patients. It is more important than ever that NHS workplaces become environments that encourage and enable staff to lead healthy lives and make encourage and enable staff to lead healthy lives and make choices that support positive wellbeing. • Everyone should feel able to thrive at work. The launch of the NHS Health and Wellbeing Framework sets out the standards for what NHS organisations need to do to support staff feeling well, healthy and happy at work .
Put on Your Oxygen Mask: Take Charge of Your Life, Learning and Prosperity Hemant Patel, NEL LPC, Secretary INDEPENDENTS Evolving Together
• The NHS Long Term Plan • January 2019 Prevention Technology Workforce
A new service model for the 21 st century Five major, practical changes 1. Boosting ‘out-of-hospital’ care and finally dissolving the divide between primary and community health services 2. Redesigning and reducing pressure on emergency hospital services 3. Enabling more personalised care 4. Making digitally-enabled primary and outpatient care mainstream 4. Making digitally-enabled primary and outpatient care mainstream 5. Focusing on population health and partnerships with local authority-funded services, through new Integrated Care Systems everywhere Backed by additional investment of at least £4.5 billion in primary and community care by 2023/24
• Preventing illness and tackling health inequalities: • Making better use of data and digital technology: • Backing our workforce: • Backing our workforce: • Getting the most out of taxpayers’ investment in the NHS: • Doing things differently: The NHS Long Term Plan
Next steps Early 2019 Spring ‘19 Summer ‘19 Autumn ‘19 March: Clinical NHS Assembly Detailed national LTP review of standards 5-year local planning established established implementation implementation published LTP national Workforce Field testing new implementation implementation plan clinical standards framework published published Workforce interim report published
Consideration of …. Doing things differently : • Transparency in outcomes • Supervision and delegation • Clinical capacity within primary care and pharmacy • Workforce development: clinical and leadership developments • Workforce development: clinical and leadership developments • Control of Entry: Closures, Hub and spoke model and robotics • Primary Care Network development: ?Pharmacy Group Practice • Premises re-design to include clinical space • IT and digital enablement • Population health sharing of data and income
Re-organisation of Community Services & Relationships • Clinical capacity • PRN service: • Community & Prevention services • MDTs and I ntegrated C are • MDTs and I ntegrated C are P rovider contracts • 10 Year NHS Plan: PCNs • Care pathways redesign with a difference e.g. AF care pathway in NEL
New Ways of Contracting Lead Provider and alliance Lead Provider and alliance agreement
New Contracts National Contracts Primary Care Contracts • Dispensing • Part of ICP network • What else • Shared goals • Shared funding • Shared funding
What are Primary Care Networks? • GP practices joining together as groups of practices working with community service providers and other health and care organisations, including community pharmacies • The NHS Long Term Plan said that all GP practices should be in • The NHS Long Term Plan said that all GP practices should be in a PCN by June 2019 • PCNs are based on GP lists, typically serving populations of around 30,000 to 50,000 patients ………80,000?
London LPCS Mapped against LPCs APRIL 2019 MIDDLESEX GROUP Enfield MIDDLESEX GROUP Barnet MIDDLESEX GROUP MIDDLESEX GROUP NEL LPC Harrow Haringey Redbridge NEL LPC Waltham NEL LPC C& I LPC Forest MIDDLESEX GROUP MIDDLESEX GROUP C& I LPC C&H LPC Camden Havering Hillingdon Brent Islington City & NEL LPC Hackney Barking and Dagenham MIDDLESEX GROUP Ealing NEL LPC NEL LPC KCW LPC Tower Central London Newham MIDDLESEX GROUP Hamlets H&F H&F KCW LPC KCW LPC MIDDLESEX GROUP West London Hounslow LSL LPC BBG LPC Southwark Greenwich LSL LPC Lambeth K & R LPC MSW LPC LSL LPC Richmond Wandsworth BBG LPC Lewisham Bexley MSW LPC K & R LPC Merton NW London STP Kingston Croydon BBG LPC Sutton Bromley NC London STP Croydon LPC MSW LPC Croydon Croydon Sutton NE London STP SW London STP SE London STP 14
What are Primary Care Networks (PCNs)? PCNs will typically comprise: • 5-6 general practices • 9-10 community pharmacies • They will have teams comprising of a range of staff, e.g. GPs, pharmacists and allied health professionals pharmacists and allied health professionals • 100-150 clinicians and wider staff • Small enough to give a sense of local ownership • Big enough to have an impact across the local population • Different names may be used to describe them locally, e.g. locality or neighbourhood teams
What Will the PCNs be Discussing? Discussing?
•From ‘virtual’ integration through shared protocols to integrated teams and in some 1. Reduce cases shared budgets and 5. More integrated dependence on both GP organisational integration models of care practices and emergency services • This will: • This will: Clinicians involved in CCGs will need to shift their focus Clinicians involved in CCGs will need to shift their focus •Improve from the patients that present most frequently in their 2. More systematic health practice to the wider population that they serve 4. A population and proactive outcomes health approach management of •Reduce chronic disease inappropriat e use of •A key challenge for commissioners hospitals is to direct resources to the patients •Have a with greatest need and redress the significant 3. Empowerment of ‘inverse care law’ impact on patients health inequalities’ Patients are arguably the greatest untapped resource within the NHS
A population health systems perspective requires: • greater pooling of data and budgets; • population segmentation; • place-based leadership drawing on skills from different place-based leadership drawing on skills from different agencies and sectors based on a shared vision and strategy; • shared goals based on analysis of local needs and evidence- based interventions; • effective community engagement; and • incentives to encourage joint working.
CVD Prevention programme: need for MDT work and system intelligence • Prevention • Complex care Hypertension • Early • Polypharmacy Diagnosis • Non-Compliance CKD AF Detection • Treatment • Treatment • Mental health • Mental health • Independent • Drug interactions Living • Problems with • Urgent care pharmacovigilance CVD risk Obesity detection Type 2 Diabetes
Are we really making the most of medicines? Only 16% of patients prescribed a new medicine take it as prescribed, experience no problems and receive as much information as they need Ten days after starting a medicine, almost a third of patients are already non-adherent are already non-adherent A study conducted in care homes found that over two thirds of residents were exposed to one or more medication errors An estimated 1.8million serious prescribing errors occurred in 2010 In primary care around £300 million of medicines are wasted every year , of which £150 million is avoidable At least 6% of emergency re-admissions are caused by avoidable adverse reactions to medicines
Cost of medication errors Cost of medication errors • Research evidence indicates the following medication error rates in the medicine use process Prescribing errors rate in general practice • 5% of prescriptions Dispensing Dispensing Prescribing Prescribing Dispensing Dispensing of which 0.18% were of which 0.18% were Medicine error rates in severe errors error rate in error rate in •With a billion administrati community prescription items hospital hospitals on errors in prescribed in pharmacies primary care in the hospital • 7% of • 0.02 – 2.7% of NHS in England • 0.01 – 3.32% annually prescription dispensed dispensed • 3 – 8% •This research items medicines predicts 1.8 medicines million serious prescribing errors each year
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