Five Year Forward View: Primary care – next steps

7 June 2017

Following the third year since the “new deal” was announced, which recognised the strain on general practice with any new funding to be aimed first at those prepared to embrace new ways of working, the review and next steps were published in March 2017.

In describing a limited range of new models, the original “new deal” envisaged the implications for primary care and, not unsurprisingly, focused on general practice with the foundation of NHS care remaining list-based primary care.

Of the two vanguard models of new organisation proposed in the Five Year Forward View, only one put GPs in the driving seat - the multispecialty community provider (MCP).  The other, similar to the accountable care organisations found in some other countries, was to see the integration of hospital and primary care providers – the primary and acute care systems (PACS) model.

In focusing on primary care, we enter the third phase where the focus shifts decisively to supporting delivery and implementation of key priorities, as detailed in the Next Steps plan.  Within the constraints of the requirement to deliver financial balance across the NHS, the main 2017/18 primary care improvement priority is:

“Strengthening access to high quality GP services and primary care, which are far and away the largest point of interaction that patients have with the NHS each year.”

So, what are the primary care achievements over the past three years and aims over the next two years?

More convenient patient access to GP services

17 million people are now able to access GP appointments at evenings and weekends.

  • Additional GPs, therapists, pharmacists and nurses
  • Improving access to convenient and needed practice appointments
  • ‘Streaming’ patients so as to offer convenient same day urgent appointments
  • Extended access to GP appointments at evenings and weekends
  • Practice profiles published - patient survey results & ease of making appointment’.

First steps to expand the primary care workforce

Additional 300 GP trainees, 491 clinical pharmacists, GP new mental health service.

  • Extra 5000 doctors working in general practice by 2020
  • GP trainees numbers up and to reach 3250 trainees per year by 2018
  • Three schemes to boost GP retention
  • Clinical pharmacists (GP) to double by 2018 with 1300 by 2019
  • Mental health therapists in primary care: 800 by 2018 and 1500 by 2019
  • Physician associates: 3000 by 2020 with 1000 in general practice
  • General practice nursing: work on considering how to improve.

Modernise primary care premises

Modernise premises, IT and equipment - 560 schemes completed; 200 in progress.

  • 800 further infrastructure projects: for investment by 2019.

Implementation

New vanguard models of scaled primary care across 23 areas, covering nearly 10% of the population, with lower growth in emergency hospital admissions than the rest of England.

  • Increase investment in GP services, by 2021 a 14% real terms increase.
  •  Encourage practices to work together in hubs or networks

o  Combined patient population of at least 30,000-50,000

o  Sharing community nursing, mental health, and clinical pharmacy teams

o  Expand diagnostic facilities, and pool responsibility for urgent care and extended access

o  federations, super-surgeries, primary care homes, and MCPs

o  Sustainability and transformation partnerships to accelerate these changes.

·         Contract reform - agree a successor to QOF, releasing £700m a year to improve:

o  Patient access

o  Professionally-led quality improvement

o  Greater population health management

o  Patients’ supported self-management

o  Reduction in avoidable demand in secondary care.

Integration

New models of care continue to be of interest to stakeholders with some preferring the MCP approach while others travel down the PACs route. While sustainability and transformation partnerships are not new statutory bodies, supplementing rather than replacing the accountabilities of individual organisations, they provide a basic governance and implementation “support chassis” to enable effective working.

With primary care contracts within an MCP or PAC framework, the aim is for STPs to evolve into accountable care systems where NHS organisations in partnership with local authorities choose to take on collective responsibility for resources and population health.

This is not a big bang but a complex staged transition which requires careful management to create opportunity while also reducing instability and managing risk.  A knowledge and overview of the whole rather than silo thinking needs to prevail in order for accountable care organisations to evolve over a number of years.

Shaping local conversations

Through facilitation and leading local discussions, PCC remains well placed to advise and provide support on:

  • GP collaborative working
  • Federations
  • Working in neighbourhood clusters
  • Formation of new care models from primary care home to larger scale MCP/PACS.

As accountable care systems evolve, comprising a range of organisations across a larger footprint, it becomes harder to navigate the complexities of the systemPCC has a range of experts to make sense of the emerging models and provide learning from examples of both success and failure.

We can provide local support through tailored workshops with local stakeholders, expert advice and speakers at local events and hands-on project management support.

For more information contact enquiries@pcc-cic.org.uk with the subject “Next steps development”.

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