Primary Care Developments in Bracknell & Ascot

1. Bracknell and Ascot Patient AssemblyLocal Primary Care DevelopmentsHelen Snowden27th September 2018

2. Local Primary Care Developments • Introductions • Who am I? • What is Berkshire Primary Care Ltd and more importantly what do we do? • Primary Care Networks • Brief history of Primary Care Commissioning • Bracknell & Ascot Transformation Plans and Network Plans • Time for Questions

3. Introductions • Helen Snowden • Berkshire Primary Care Ltd • The Practices • The structure • The Board

4. Berkshire Primary Care (BPC) Ltd Our set up: Practices / Members / The Team Our mission Statement: To empower General Practice to provide high quality patient focused services to encourage a healthier population

5. BPC Achievements to date • Extended Hours GP Service • Staff • IT • Homeless project • Workflow / Administration efficiencies • At scale discounts • BOC • Legionella • Appraisal toolkits • Training / e-learning

6. BPC Current Projects • Bracknell and Ascot Transformation Plan • Bracknell and Ascot Network Plan • New way for funding to be released / services to be commissioned

7. A brief history of Primary Care funding & commissioning • 1991 - 1997/8 Primary Care Fundholding • GPs were first given own budgets to commission services / care for patients. In 1993 report by Audit Commission said there was a lack of commissioning expertise and that some GPs had pursued their own interests and agendas and National objectives had not been supported or addressed. • It was identified that there was a need for commissioning to be organised more cost effectively. • 1999-2000 Development of Primary Care Groups (481 PCGs) • Primary and Community Health services working in a single organisation with a unified budget to deliver healthcare to communities. • 2000-2004 Development of Primary Care Trusts (303 PCTs) • PCGs merged to become PCTs to enable the increase of managerial resources and to achieve greater integration on primary care and community services.

8. 2004 New GP Contract • Prior to this, GPs had been paid as individuals and paid for each patient on their list and each piece of work they did. New contract contracted the Practice rather than individual GPs and changed the way they got paid; introduced Quality Outcome Framework (QOF) and Enhanced services. Paid for quality of care given to each patient based on patient health care needs. • 2012 Health & Social Care Act – Redefined what good Healthcare should look like • 2013 Development of Clinical Commissioning Groups (195 CCGs) • Responsible for implementing the roles set out on the Health & Social Care Act. CCGs plan and commission primary, community and hospital care and mental health services. They work closely with NHS England and Public Health on prevention agenda. • 2014 NHS Five Year Forward View Plan • NHS unable to cope with growing and aging population. Aim to provide more care closer to home and break down barriers between services. • 2017 Updated Forward View Plan • “Aim to use the next several years to make the biggest National move to integrated care” NHS England. General Practice Forward View (GPFV) Transformation Plans introduced.

9. Bracknell & Ascot Transformation Plan 370 million GP Consultations per year Nationally. National GP and Nurse shortage. Needed to think differently and transform services. • General Practice Clinical Pharmacists • Home visiting service • Paramedics / specialist Nurses • General Practice Physiotherapists

10. General Practice Clinical Pharmacists Shared Team across Bracknell & Ascot • Medication Reviews • Discharge Summaries • Prescription Queries • Long Term Condition clinics • Advice and Guidance

11. Home visiting service Shared Team across Bracknell & Ascot • Specialist Paramedics • Early visits – reduced admissions • Long Term Conditions trained • Direct links to Practice Team • Joined up IT • Share staff with South Central Ambulance Service

12. General Practice Physiotherapists Pilot project for Binfield, Evergreen & Gainsborough Practices • Musculoskeletal (MSK) First Contact Physiotherapists Assessors • Book directly into Physio assessment, without need for GP referral

15. A brief history of Primary Care funding & commissioning cont’d… • 2018 Introduction of STPs / Integrated Care Systems

16. What are Integrated Care Systems (ICS) • In an ICS structure, NHS organisations working together to meet the needs of their local population and improve people’s health. • Enables more effective use of resources as organisations can share budgets, staff and resources where appropriate and money can move flexibly between organisations • The agreement is to collaborate rather than compete! • ICS areas have to work together at scale and demonstrate they are making progress in taking forward the ambitions of the • There are currently 14 Integrated Care Systems Nationally • East Berkshire comes under Frimley Health ICS

17. What are Primary Care Networks (PCN) • Each ICS has been broken down into Primary Care Networks. • 9 Networks in Frimley ICS: • Aldershot, Bracknell and Ascot, Farnborough, Farnham, Fleet, Slough, Surrey Heath, Yateley, Windsor, Ascot & Maidenhead. • Networks in East Berkshire: • Bracknell & Ascot • Slough • Windsor, Ascot & Maidenhead

18. Primary Care Network Benefits Summary

19. Primary Care Network (PCN) Plans • Each PCN has to submit a PCN Plan. • New method for funding to be streamed to primary care (no longer via CCG or Federations) • Plan has to align with CCG and ICS priorities • But…enables primary care the chance to choose own localised priorities based on local data

20. Bracknell & Ascot PCN plan content3 Key areas for reduction in variation (based on CCG & ICS priorities and local data) 1. Primary Care Sustainability – Workforce 2. Primary Care Access – Urgent Care 3. Primary Care Quality – Reducing Clinical Variation

21. 1. Primary Care Sustainability – Workforce There is a national shortage of GPs and Nurses so need to think differently about recruitment. New potential roles include: • Practice Pharmacist • Nurse Practitioner • Practice Physiotherapists • Paramedics • Physician Assistant • Health Advisors or Community Co-ordinators • Wellbeing Coaches or Health Trainers • Clinical Personal Assistant

22. Primary Care Sustainability – Workforce Is this affordable? Whilst in larger practices there may be an opportunity to deploy some of these skills full time, many of them will be most effective if they operate across a number of practices.

23. 2. Primary Care Access – Urgent Care Urgent Care is a condition or illness needing attention the same day, but is not life threatening or life changing. Currently, these services are provided by a range of professional and through a variety of access points.

24. Primary Care Access – Urgent Care We want to be able to: Be open for at least 12 hours a day seven days a week, including bank holidays. Be staffed by a range of healthcare professionals including GPs, Nurses, Clinical Pharmacists, Physiotherapists, Mental Health Workers and others. Provide pre-booked, same day and walk in appointments with an emphasis on patients contacting 111 for a booked appointment.

25. We also want to be able to… Help patients to self-care by providing health information and education. Provide a range of diagnostic testing such as blood tests and ECGs and access to x-ray, USS. Issue prescriptions only where clinically appropriate Provide better access to mental health services Continue to offer British sign language interpretation and translation services

26. and there’s more… Offer more services in the community to support people to remain in their home (where clinically appropriate to do so) Work better to identify and respond to those who are risk of being hospitalised. Provide an Urgent Care Services that are convenient, accessible and allow patients to access the level of care most clinically appropriate to manage their condition. To improve access to advice and treatment for urgent Paediatric issues

27. 3. Primary Care Quality – Reducing Clinical Variation There is a local need to understand the variation in the care “offered” and the care “accepted” between demographically similar populations. This will allow us to adopt and implement better care pathways, more efficiently and effectively.

28. Examples in the plan In Ascot and Bracknell there is a lower than average number of patients reported and estimated with hypertension and a lower % of patients whose Blood Pressure (BP) is <150/90. Plan is to improve self-management and screening within GP practices through the purchase of self-screening blood pressure devices for GP waiting rooms and the subsequent offer of 24-hour BP diagnostics.

29. Another example Patients with Learning Disabilities should be have an annual physical health check. The current figures show only 63% had one last year. Plan is to look at potential barriers and find solutions to improve this: • Administration • Clinical training • Access to appointments • Patient education

30. Synopsis • We are working hard to make improvements • We are working differently to create opportunities • We are working together to do things better • We want you with us to help make it happen