General Practice Transformation Champions, 28th March 2019, Novotel Hammersmith, London

1. Sheinaz Stansfield
@sheinazs
• Practice Manager: Oxford Terrace and Rawling Road Medical Group
• Development Advisor: NHSE Sustainable Improvement Team
• National Social Prescribing Network Steering Group Member
• National Association of Primary Care Council Member
• RCGP North East Faculty member
• NHSNGCCG Board Member
Primary Care Networks
“The Art of the Possible”
A Practice Managers Perspective
28th March 2019

2. A Five Year Framework for GP Contract Reform
Framework For GP Contract Reform

3. Time Scales

4. Purpose Function & Form
Purpose
Before Function
Before Form

5. • Merger/Two sites
• 15.700 Patients
• 2500 high admission
risk
• All long term conditions
• Hospital stay longer
• Deaths earlier etc etc
• High Dementia Prevalence
• PMS
• 8 Care Homes
• Substance Misuse
Oxford Terrace & Rawling Road Medical Group
“Passionate about Complex care”
Culture of Continuous Quality Improvement

6. PCNs Leadership Challenges
1 Managerial Effectiveness
• Culture eats strategy for breakfast
2 Inspiring Others
• Grumpy, lonely, no support, personal development
3 Developing Employees
• Thinking differently doing things differently
• New roles, new skills
4 Leading a Team
• Operational Management
• Partner Priorities
5 Guiding Change
• Reactive, No Skills, Isolated
• Not Partner Priority
6. Managing Stakeholders & Politics
• No Influence
Centre for Creative Leadership 2013

7. Primary Care Networks
The Health & Care Change Model: A Starting Point
Our Shared Purpose
• Effectiveness
Leadership by all
• Developing the team: Leading not managing –
Developing others, Mentorship & Coaching
Motivate and Mobilise
• Inspiring Others
Spread and Adoption
• Don’t reinvent the wheel
• Learn from each other
Quality Improvement tools
• Leading a Team
Project Management and Performance
• measurement
• Guiding Change
System drivers
• Managing Internal/External Stakeholders
• Engaging and informing

8. Workforce
• July 2019 Additional Roles Reimbursement Scheme
• 2019 Pharmacists 70%, Link worker 100%
• Network decides who employs staff
• Beyond 100,000 network size reimbursement doubles to 2wte.
For 200,000 four of each
• 2020 physician associates, first contact physiotherapy, first
contact community paramedics 70% funding
• 20/21 allocation in single combined sum for all five staff roles –
based on fair share weighted allocation – (weighting to be
confirmed in 2019)
• Fellowship Scheme: newly qualified nurses, GPs, training hubs
• New roles and inter-disciplinary credentialing programmes
enabling workforce flexibility across an individual’s NHS career
and between individual staff groups.

9. Demand and Capacity
• 2019 extended access - the extended access DES
transferred into the network DES
• £6 per head to follow
• Data relating to activity, capacity and waiting times will
be published alongside secondary care data
• April 2019: One appointment per 3000 patients NHS
111 direct booking into practice appointments
• July 2019: Practices expected to make 25% of
appointments bookable online
• April 2020: all practices provide online & video co
consultations (further guidance awaited)
• April 2021 digital first support – from agreed list of
providers.
• A new measurement of patient reported satisfaction
with access and data
• The state-backed indemnity scheme will begin in April
2019 and cover all practice staff and those working in
out-of-hours for clinical negligence claims.

10. Workforce Redesign Model

11. Managing Demand Differently
• Workforce
• Transformation of Nurse
team
• Frailty Nurse
• Primary Care Navigators
• Health & Wellbeing Co-
ordinator
• Practice Based Occupational
Therapist
• Practice based Community
Matron
• Older Peoples Specialist
Nurses
• Extended Training:
Pharmacists, Nurses, Nurse
Associates
• Practice Based Research
Emergency
Health Care Plan

12. Integration
• The £4.5 billion: expanded community
multidisciplinary teams aligned PCNs
• Services configured around network footprints
• break down traditional barriers for people with long
term conditions, person centered care.
• Over next 5 years increase in capacity and
responsiveness of community/intermediate care
service
• Deliver services within 2 hours of referral
• Reablement care within two days
• Fully integrated community health care, supported
self-care, connected to pharmacies,
• By 20/21 work with community services to assess
population health/risk of unwarranted health
outcomes
• Work with moderate frail patients on early
intervention and prevention
• MDT – comprehensive model of personal care
Identify and support people with dementia

13. Signposting; Care Navigation; Social
Prescribing??

14. Managing Demand- Through Care Navigation &
Social Prescribing
• Dementia Screening + 117
• Assessment for Dementia +38
• Carers Register + 43
• Veterans Register + 20
• Care Plans +396
• NHS Health Checks + 95
• Post discharge + 86 none of whom needed a
physician as PCN sorted
• Reduction in discharge letters suggesting avoided
admissions – from 7 to 8 a day to 2-3 a week, within
first six months
• more effective in ringing patients following
emergency admission
• less fragmentation
• reception managing better
• improved communication
• less prescription errors
• more co-ordinated personalised care
Now Extended to Long Term Conditions/Full Practice Population

15. Personalised Care Planning
• Shared decision
making
• Personalised care
and support planning
• Social prescribing
and community-
based support
• Supported self-
management
• Personal health
budgets and
integrated personal
budgets.
• Patient Choice,
including legal rights
2020
• structured medication reviews,
• enhanced health in care homes,
• anticipatory care (with community
services),
• personalised care and supporting early
cancer diagnosis.
2021
•cardiovascular disease case-finding
•locally agreed action to tackle inequalities

16. Priorities
PCN Priorities
• Elect Clinical Lead
• Elect non-clinical lead
• Identify lead practice to hold budget
• Identify lead practice/s to appoint pharmacist and or
link worker
• Agree link worker/pharmacist role
• Set out in the network agreement.
(Governance/agreement being developed nationally)
• 2019 extended access - the extended access DES
transferred into the network DES
• What is your why?
Practice Priorities
• April 2019: All new patients access to their digital
records
• April 2019: Electronic Prescribing Service
• April 2019: All patients should be able to order repeat
prescriptions electronically
• April 2019: One appointment per 3000 patients NHS
111 direct booking into practice appointments
• July 2019: Practices expected to make 25% of
appointments bookable online

17. He who has a why to
live can bear any how