Time for Care. South & North Tandridge Network Group Training Event

@robertvarnam #NHSLongTermPlan@robertvarnam #NHSLongTermPlan
Time for Care
Dr Robert Varnam PhD MRCGP MSc
Director of Professional Leadership for Improvement
Improvement Directorate
NHS England and NHS Improvement
@robertvarnam
bit.ly/190515tandridge

@robertvarnam #NHSLongTermPlan
Pressure Opportunity

Continuity Accessible personal
care built on a relationship from cradle
to grave
Community focussed Responsible for
a registered population, improving wellbeing
Holistic Dealing with the patient as a
person not a disease or part of the body
Comprehensive Handling wide range
of problems, managing clinical uncertainty
STRENGTHS OF PRIMARY CARE
Central Coordinating and connecting
other teams, referring where appropriate

Continuity
Community focussed
Holistic
Comprehensive
STRENGTHS OF PRIMARY CARE
Central
BUT …
Demand >> workforce
Practices are set up to provide
mostly medical care (reactive,
individual > proactive, population
focused)
Most lack collaborative
relationships required to truly be
central to patients’ care
Too small and isolated to have
significant impact on population or
system

Primary care networks: Opportunities for practices

 Staff pooling
• nurses, reception & clerical staff,
sessional GPs … internal ‘bank’
 Overflow support
• phone consultations
• access hub (phone +/- face-to-face)
• home visiting

 Purchasing
• Indemnity bulk purchasing
• Supplies & utilities
 Shared functions
• CQC registration
• Accounting
• Policies & procedures
• Procurement
• Correspondence management
• IM&T (eg support & maintenance, intranet, web,
social media)
 Specialist functions
• HR
• Finance
• Clinical governance
• Business intelligence

 Planning
• Workforce
• Infrastructure development
• Service reconfiguration
• Public health
 Provision
• Acute care
• Community pharmacy
• Dentistry
• Optometry
• Social care
• Housing
• Welfare
• Voluntary sector

 Traditional healthcare roles
• Pharmacists
• Specialist nurses
• Physiotherapists
• MH therapists
• Paramedics
 Wellbeing workers
• Social workers
• Care navigators
• Health trainers & coaches
• Welfare advisors

 Sharing ideas
 Testing new ideas
 QI expertise
 Patient engagement
 Analytics
• Population health analytics
• Priority setting
• Benchmarking
• Realtime measurement
 Project management
 Research participation

 Recruitment
 HR
 CPD
 Career development
• New options
• In-house portfolio career
• eg
• Teaching
• Leadership
• Mentoring
• Service improvement
• Research

Benefits are not automatic
Some mergers achieve little
Some ‘alliances’ achieve much
You need a deliberate plan

System: 1m+
“Integrated care system”
Major partnerships & shifts in priority
Workforce & infrastructure planning
Large scale service reconfiguration
Place: 100 – 500k
“At Scale Primary Care Provider” / “Federation”
Organisational infrastructure & governance
Specialist staff & services
Employment & career development
Model design and population wellbeing
Partnerships with all health & care providers
Neighbourhood: 30-50k
“Primary Care Network”
Urgent care and resilience
Locality-tailored services
Shared MDT
Partnerships with local providers
General practice
Coordinated, complex, multidisciplinary
care
‘Place of belonging’ for patients needing
continuity
Doing the right thing at the right scale

Building meaningful collaboration

1. It’s pivotal
The quality of collaboration,
and the extent to which it
pervades the whole culture
for all staff, is one of the
biggest determinants of
success or failure in joining
up care.
2. It’s hard
Success is not guaranteed,
and doesn’t “just happen”
without deliberate effort
and clear plans.

Common pitfalls
• Ignore it as an issue
• Talk about theories / governance
• Focus on our differences
• Keep talking until every detail is planned
BUT …
• Most people in general practice are very practical
• There is more that connects us than separates us
• We can’t fully know what the future holds

So how about …
 Talk: share what you’d like to achieve
 Agree: one or two things to do - together
 Do it: work on those improvements together
 Then: develop structures to sustain the new ways of working
‘Collaborate’ is a verb, not a structure

Manage our workload better

74%
7%
6%
4%
3%
3%
2%
2%
Potentially
avoidable GP
appointments
(audit by GPs)
Other in practice
Self care/Pharmacy
Outpatients
Sick notes / appeals
Care navigation
Continuity/preparation
Other
Data from 5,128 consultations
bit.ly/time4caretool1
GPs judged 26%
of their consultations
to be potentially avoidable

74%
7%
6%
4%
3%
3%
2%
2%
Other in practice
Self care/Pharmacy
Outpatients
Sick notes / appeals
Care navigation
Continuity/preparation
Other
Data from 5,128 consultations
bit.ly/time4caretool1
GPs judged 26%
of their consultations
to be potentially avoidable
… 18% are about
how the practice
manages its workload
Potentially
avoidable GP
appointments
(audit by GPs)

GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions
Innovations from around England
that release time for GPs to do
more of what only they can do.
bit.ly/gpcapacityforum

Innovations from practices
throughout around England that
release time and improve care.
GENERAL PRACTICE

Your own Time for Care programme
bit.ly/T4Cmay2019

Time for Care. South & North Tandridge Network Group Training Event

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