Primary Care in NHS Grampian

1. Primary Care in NHS Grampian By Richard Carey CE, NHSG

2. Introduction • Policy drivers • Local direction setting • Why focus on Primary Care? • Primary Care – key themes • DQPC - Local successes and works in progress • Planning • The way ahead…

3. Policy Drivers • Equally Well • Healthcare Quality Strategy • DQPC – delivered by CHPs – NHSG supporting • Shifting the Balance of Care • Re-shaping care for older people • DoH White Paper – Liberating the NHS – Scottish implications • A revised GMS contract – Quality and productivity in PC • Optometric and pharmacy and contract changes • Dental changes • Delivering better outcomes and use of joint resources – audit of CHPs

4. NHSG Local Direction Setting • Healthfit /Grampian Health Plan • Developing Health and Care Framework – transformational change – connect the levels • Patient Safety Programme – moving into primary care • Developing Health Promotion Framework • Transformation plans - the Change Fund • CLINICAL LEADERSHIP and engagement

5. Why focus on Primary Care? • The availability of primary care is positively and consistently associated with improved outcomes, reduced mortality, lower utilisation of health care resources, and lower overall costs of care

6. Hallmarks of Primary Care • First contact care, gate keeper of the health system • Continuity of care, life long care? • Comprehensive care • Coordinated care, Integrates with acute care and social care • Cost effective care • Part of a whole system – prevention to end of life care

7. Key themes • Access • Maximise Enablement and self care • Cared for in your own environment from cradle to grave • Primary care focus on supporting self management, care in the community, increasingly delivering more complex care • Local accessible services • Specialist focussed on specialist care provision and supporting the system to achieve the above

8. NHSG - Primary Care, key themes • NHSG enabling patients to “take control of the determinants of their health” (enablement & self care) • NHSG supporting residents in their own homes (rehabilitation) • NHSG providing services in patients own homes and communities close to friends and families • NHSG expanding primary care to deliver care to the patients – utilising all contractor services and other care professionals - through Shifting Balance of Care • NHSG expanding local and direct access diagnostic and treatment services • NHSG providing care in acute settings (GP acute as well as secondary care) • NHSG supporting contractors to deliver on their respective contracts • NHSG supporting access to primary care services – cross contractor and cross discipline

9. DQPC -Local successes and works in progress…. • Shifting the Balance of Care • Clinical leadership • Care pathways • Prevention and anticipatory care • Self care and self management • Patient safety • Challenges to making this happen

10. Local Successes – Shifting the Balance of Care • Minor Surgery • Diabetes • Eye health Network • GPs wSIs – eg orthopaedics, dermatology • Physiotherapist wSI, orthopaedics • Dental Practitioners with Special Interest - developing • Minor Injury Nurse service within Community Pharmacy • Ultra sound scanning – shared training across GPs and Consultant staff • The future – reshaping care for older people

11. Local Successes – Clinical Leadership Locally • Aberdeen City Primary Care Redesign • Moray Federation • Aberdeenshire CHP Redesign • Optometry Leads per CHP • Dental Leads per CHP • Pharmacy primary care redesign – on-going • PCIMG – cross contractor and service leadership

12. Care Pathways – under development • Cardiology • Dementia • COPD • MSK – national and local • Referral management pathways – various • Direct access diagnostics, eg endoscopy • Clinical guidance intranet (CGI)

13. Prevention and anticipatory care……

14. Prevention and Anticipatory Care • Keep well • Well North • Anticipatory care LES • Alcohol brief interventions • Eye health checks • Toothbrushing/ Childsmile • Smoking cessation… • Keeping people at home – complex med mgt

15. Self care and self management • Know who to turn to… • Use of assisted technology • COPD • Rehabilitation and re-enablement

16. Patient safety • Medicines management – polypharmacy review • Reducing healthcare acquired infection – use of ‘4c’ antibiotics; hand washing • Improved communication between primary and secondary care

17. Challenges… • Finance • Infrastructure • Data management and information, data quality • Performance management • Maintaining and improving cross system dialogue

18. Finance!!! • National Spending Review • Capital finance more limited • More challenging financial environment • SAW/SANE • CSI, Lean approach • Joint working with partners – Local Authorities, Third Sector • Opportunity from challenge!

19. Infrastructure • Premises in Primary care fit for purpose? • Capital funds reductions • Impact from Hub Co • E-health connectivity – linking with all contractor services in the community

20. Performance management • QOF • ES reports • Dental registrations • Referrals to HES from optometry/GPs • CMS – MAS data • HEAT • ABI • Health Checks • Child smile – Fluoride Varnishing • Smoking Cessation

21. Planning in Primary Care • Developing process • Clinically led, managerially supported • Whole system focus • On-going dialogue

22. So………. • Let’s think about Primary Care as the solution • Let’s think about how we incentivise and resource the system to work better for patients and improve effectiveness and quality • Significant change is needed – change role of patient – passive to active…. Working with communities and individuals • Significant change is needed around the way we work together…

23. The way ahead… • Engagement and involvement of Primary Care Clinical Leaders; working across the system • Working in partnership with LA and Third Sector colleagues, joint management models? • Transformational change of our workforce • Continual drive to improve quality – DQPC, Patient Safety- within financial frameworks • Maximise self care and self management • Focus on patient pathways and anticipatory care

24. Your turn….. • Have your say and • Enjoy the day…