Future of General Practice and Workforce Development

1. Future of General Practice andWorkforce Development Dr. Nadim Fazlani Chair Liverpool Clinical Commissioning Group

2. Birth of the NHS

3. Birth of NHS • 5 July 1948, following an official unveiling at Park Hospital (now Trafford General Hospital) by Health Secretary Aneurin Bevan • NHS will last as long as there are “folk left with the faith to fight for it". • 1,143 voluntary hospitals with some 90,000 beds and 1,545 municipal hospitals with 390,000 beds are subsumed within the new NHS.

4. Core Principles of the NHS

5. Core Principles of the NHS • The health service would be available to all and financed entirely from taxation • That it meets the needs of everyone • That it be free at the point of delivery • That it be based on clinical need, not ability to pay

6. Crisis in general practice

7. Crisis in general practice • 2007 average patient 3.19 consultation • 2013 average patient 6.34 consultation • Last ten years, the number of hospital consultants is up by 76% in whole-time equivalent terms • No SAS equivalent in general practice • Not clear numbers of full time equivalent in General Practice

8. Crisis in general practice • the number of GPs per 100,000 head of population across England 54 in 1995 and in 2009 was 59.5 • 65% trainees in General practice females • 40% of women who leave practice each year are under the age of 40 • HEE target is 3250 GP trainees per year • Trainee numbers stuck around 2700

9. Crisis in general practice • Lack of training capacity • 2013, 4100 (60%) doctors entered hospital specialty training compared with 2800 (40%) doctors into GP training • 2% reduction in medical students intake • The overall applicant pool is not big enough to support GP expansion without proportionate reduction in specialty training numbers.

10. Have we been here before?

11. Have we been here before? • 1957 John Pringle, the BMA's press officer, announces that GPs are being advised to resign from the NHS and return to private practice. 5 shilling for consultation • 1966 Cartwright found GPs complaining of neglect and impoverishment. Morale is poor and recruitment is proving difficult.

12. BMJ Obituary • General Practice died on 31st March 1990 after a turbulent illness in large part precipitated by the importation of industrial management into general practice.

13. Principles of designing future • Working in multidisciplinary micro-teams • Integrating generalists and specialists • Federated organisations (organised networks of teams) • Modernising the patient-clinician consultation • Flexible and remote types of consultation

14. New Care Models • Multispecialty Community Providers • Primary and Acute Care Systems • Viable smaller hospitals • Urgent and emergency care networks • Consolidated specialised services • Modern maternity services • Enhanced health in care homes

15. Structural Models (UK)

16. Structural Models (UK) • Community health organisations (Bromley by Bow Centre) • Regional and national multi-practice organisation(Hurley Group,The Practice PlC ) • Marginalisedgroups (Leicester Homeless Primary Health Care Service,) • Networks or federations (Tower hamlets) • Professional chamber (Pallant Medical Chambers)

17. Structural Models (UK) • Super-partnerships(Whitstable Medical Practice) • Super-partnerships with inpatient facilities (Nairn Healthcare Group)

18. International models • Accountable care organisations • Community-owned(Hokianga Health Enterprise Trust, New Zealand) • Specialist primary care(ParkinsonNet, the Netherlands) • Vertically integrated systems( Kaiser Permanente, USA0

19. Making it happen • Workforce Development • Scaling up and keeping it local • Infrastructure • Leadership

20. Role for CCGs

21. Role for CCGs • Can already commission additional services from general practice (over and above core general and primary medical services) • Co-commissioning Primary care , greater role of CCGs’ involvement in developing, commissioning and assuring the quality of primary care. • To work closely with patients and public to design and develop high quality primary care

22. Workforce Transformation Developing a workforce responsive to changes in care, now and in the future Ensuring sufficient supply of highly skilled staff Up-skilling staff Developing and promoting new ways of working

23. Primary Care Workforce Transformation Programme to September 2015 August 2014 • Now • Data collection, analysis and modelling • GP expansion programme • Assistant Practitioners • Advanced Practitioners • Community Specialist Practitioner • Expanding student placements in primary care • An anticipated allocation for CPD • An anticipated allocation for 12 GP returners across North West • Near Future • Conversion programme (secondary to primary) • Foundation programme (Practice Nurses) • Care Certificate for HCAs • Expansion of apprenticeship programme into general practice and community-based care • £150k for return to nursing • Opportunities • Build multi-professional training capacity, exploring e.g. the federated education practice model • Scope and develop new roles if required e.g. physician associate, health co-ordinators • Career framework – clinical and non-clinical staff • Exploring peripatetic model for practice supervision

24. Any Questions?