Dr James P Kingsland, The National Association of Primary Care, presents some lessons from his experience implementing new models of primary care.

1. Large scale general practice: can we rise to the challenge?
#largescalegp
The Primary Care Home – A solutions focussed new care
model provider
Dr James Kingsland, President, National Association of Primary
Care @JamesPKingsland
Chair: Dr Brian Fisher, Vice Chair, New NHS Alliance
@fisher0606

2. Dr James P Kingsland OBE
Senior Partner in General Practice
President, The National Association of Primary Care
Chair, Jhoots Pharmacy Group
Non-Executive Director, Clatterbridge Cancer Centre (CCC NHS FT)
Director, Waring Health Ltd

3. Retention, return to practice,
re-energising and meeting patient need
“If you land this - I am deferring my retirement”
General Practitioner - Newcastle
“If we are able to do this, I am returning to practice”
General Practitioner - Nottingham
“You know…I read this and it made me feel young again”
Practice Manager - Liverpool
“I’ve lived in the same house for 50 years. Being able to access one of these would make
me move”
National Patient Representative Body
“It’ the first time in a long time that I’ve really felt valued”
- District nurse in RTS

4. New Care Model Style
Primary Care Programme
• The Primary Care Home
• A complete clinical community
• Size really does matter
• Learning from success – budgetary control

5. The Primary Care Home
What it is
• An opportunity to really transform first contact care
• A shift to focus on primary care provision
• An attempt to involve a ‘complete community’ in the make or buy decisions
in daily practice
• A drive to improve efficiency in the deployment of NHS resource usage
through accountable care
• One system, one budget to provide care to a defined population

6. What it is not
• A return to any previous reform of the internal market, especially fund holding
• An NHS management reorganisation or requirement for new legislation or
regulations
• A focus on general practice profitability or new income streams
• A sub-set of the CCG
• Locality commissioning
• A new idea

7. Why reforms fail
• Cultural persistence
 Difficulties in creating the right environment in which reform can flourish
 Behavioural malalignment
 Inconsistent sets of values
 Culture inherently focused at status quo and centralised control
• Leadership remains positional
 Distributed leadership articulated but not implemented
 Delegation becomes too difficult
 Disenchanted and disenfranchised majority who do the work
• Tools to do the job withheld from the front line
 Data analytics to inform decision making
 Meaningful metrics
 Develoved budgetary responsibility (if not full accountability)

8. The Future of Commissioning in the NHS
• Evolve and devolve
• Demand and Divvy – ‘is over’
- No more block contracts
- Pay for actual activity
- Referrer defines the service requirement through referrals
• Current model is unsustainable
• Uncontrolled / unchallenged activity must cease
• Release resource tied up with other providers
• Without referrer responsibility the risk is greater, engagement is the key – smash organisational
boundaries
• This is over 10 years old