www.england.nhs.uk @robertvarnam Can practice managers save the NHS? Dr Robert Varnam Head of general practice development [email protected]@robertvarnam CHEC 25 June 2015 bit.ly/ 20150625chec
56
Embed
Can practice managers save the NHS (CHEC practice manager masterclass)
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1. www.england.nhs.uk @robertvarnam Can practice managers save
the NHS? Dr Robert Varnam Head of general practice development
[email protected] @robertvarnam CHEC 25 June 2015
bit.ly/20150625chec
2. www.england.nhs.uk @robertvarnam
3. www.england.nhs.uk @robertvarnam One of the things
motivating me as I first looked outside the walls of our practice,
to lead some local service redesign for diabetes, was fear. A fear
that general practice, despite being a service depended on by the
country, had a very uncertain future. In fact, I was afraid that
general practice was being run into the ground. Although NHS
spending was rising, with growing amounts of staff and money, the
majority was going elsewhere in the system. Even though we were
talking increasingly about the importance of providing more care
outside hospital, the investment was going inside hospital. What
future for general practice?
4. www.england.nhs.uk @robertvarnam What future for general
practice? workforce premises
5. www.england.nhs.uk @robertvarnam The founding principles of
UK primary care are admired the world over, and rightly so. General
practice is a jewel in the crown of this country. Right now,
general practice feels in a bad place. Constrained, hemmed-in and,
to some, marginalised. Whatever the state of things in your part of
the country, in general, I think its fair to say that, at the very
least, general practice is currently constrained from delivering
its full potential. We need to see increases in funding, a growth
in the workforce, and improvements to premises. Without those,
existing services may not be sustainable. What future for general
practice?
6. www.england.nhs.uk @robertvarnam But something else has been
happening in general practice, too. People are working on some
quite new approaches to care and the very organisations we work in.
This too was a big theme in the Call to Action. We asked what
practices were working on, and what would need to be done for
improvements in care to be sustained. And we heard a very big set
of messages about the future bit.ly/c2aGP bit.ly/nhs5yfv How are
things? Where are you heading? How could the system help?
7. www.england.nhs.uk @robertvarnam Actions to strengthen
primary care Stabilising core funding for general practice
nationally Co-commissioning to shift care from acute to community
Improving access to services and supporting new ways of working
Expanding number of GPs: recruitment, return to work schemes and
retention & investing in other new primary care roles Expanding
funding to upgrade primary care infrastructure and scope of
services offered to patients New initiatives to provide care in
under-doctored areas Building the publics understanding that
pharmacies and online resources can help them with minor ailments
Identifying practical solutions to reduce bureaucracy and reshape
appointment demand. Taking existing primary care strengths, we will
build a firm foundation for the future and deliver a new deal for
primary care by:
8. www.england.nhs.uk @robertvarnam ?
9. Its too easy to approach challenges just by thinking we need
more. The NHS has a well established habit of this new initiatives,
new challenges or opportunities are usually met by us talking about
more. More money, more staff or both. And, we know that, in general
practice, we do need both more money and more staff. BUT and its a
big but just doing more of the same is simply not going to cut it
any longer. Not just more of the same
10. www.england.nhs.uk @robertvarnam It is very clear that
everyone is talking about change. In many parts of the country,
change is already underway in a wide range of areas. This actually
makes it even more important to ensure were clear about why. What
is the case for change? Where are we heading with it? If youre
currently engaged in a programme of change in your practices, are
these two things really clear?
11. www.england.nhs.uk @robertvarnam Why change? Scottish
School of Primary Care
12. www.england.nhs.uk @robertvarnam So why are people talking
about change? Its partly about the pressure were under right now,
and partly about the huge opportunity to do something better. And,
for once, the same changes that would help with one are also
necessary for the other. Pressure Opportunity
13. Health & wellbeing-promoting care Right access
Consistently high quality Holistic, personalised, proactive,
coordinated care
14. Phone first. Community diagnostics. Practice based
paramedics. Pharmacy first. Web consultations. Primary care led
urgent care centre. Minor injury service. Physio first
15. Direct specialist advice. Condition management training.
Shared records. Care coordination. Hospital in-reach. Care home
ward rounds. Virtual ward. Primary care-employed specialists.
16. Social prescribing. Travelling health pods. Peer-led
walking groups Health coaching. Befrienders. Schools outreach.
Community development.
17. www.england.nhs.uk @robertvarnam What may the future look
like?
18. 1. What kind of care? 2. What kind of work? 3. What kind of
organisation?
19. 1. What kind of care? 2. What kind of work? 3. What kind of
organisation?
20. www.england.nhs.uk @robertvarnam 1. What kind of care?
Holistic, comprehensive, cradle-to-grave family care Health &
wellbeing-promoting care Right access
21. www.england.nhs.uk @robertvarnam 1. What kind of care?
Holistic, comprehensive, cradle-to-grave family care Health &
wellbeing-promoting care Right access (time, place, person, care)
Personalised, proactive, coordinated care Consistently high
quality
22. 1. What kind of care? 2. What kind of work? 3. What kind of
organisation?
23. www.england.nhs.uk @robertvarnam 2. What kind of work?
Segmented (one size does not fit all) Multiprofessional teamworking
bring new skills work to the top of our skills Partnership with
patients & community Longer consultations with fewer patients
GP not always 1st port of call Direct access diagnostics Pull-in
specialist advice
24. www.england.nhs.uk @robertvarnam Wider primary care at
scale Redirecting demand (self care, pharmacy) Intelligent
front-end (signposting, self care, coordination) Consultation
channel (online, phone, video, face) Match capacity & demand
(scheduling, broader workforce) Care model (continuity, proactive
& coordinated care) Release capacity Extended hours (evenings
& weekends) Capabilities for service redesign PM GP Access Fund
Wave one Wave two 57 schemes 2500 practices 18m patients
25. 1. What kind of care? 2. What kind of work? 3. What kind of
organisation?
26. www.england.nhs.uk @robertvarnam bit.ly/nhs5yfv New types
of organisation Multispecialty Community Providers Primary and
Acute Care Systems
27. www.england.nhs.uk @robertvarnam Multispeciality Community
Providers GP practice GP practice GP practice GP practice GP
practice GP practice GP practice GP practice Specialists
Pharmacists Community provider SC provider VCS VCS VCS MH Trust VCS
VCS VCS
28. www.england.nhs.uk @robertvarnam Primary and Acute Care
Systems Community provider SC provider VCSMH Trust Acute provider
GP practice GP practice GP practice GP practice GP practice GP
practice GP practice GP practice
29. www.england.nhs.uk @robertvarnam Purpose > function >
formPurpose > function > formPurpose > function > form
3. Design rules for organisations Purpose > function > form
a) Pick something to improve for patients b) Improve it together c)
Build infrastructure to enable, accelerate & sustain
30. www.england.nhs.uk @robertvarnam 3. Design rules for
organisations
31. www.england.nhs.uk @robertvarnam eg Whitstable medical
practice
32. www.england.nhs.uk @robertvarnam eg GP Care federation,
Bristol
33. www.england.nhs.uk @robertvarnam 3. Design rules for
organisations Bigger Personal Capable Yours
34. www.england.nhs.uk @robertvarnam 3. Design rules for
organisations Big enough for: resilience collaboration broader
workforce minor illness nurses, pharmacist, MH practitioner,
welfare rights, OT, physio, LTC nurses, HCA, physicians assistants
pull-in power economies of scale meaningful accountability eg
collaboration covering 30,000+ patients
35. www.england.nhs.uk @robertvarnam 3. Design rules for
organisations Capable: leadership strategic, transformational, team
partnership with patients and the public contribution to & from
community, accountability, patients as partners in improvement
workforce building & running effective multiprofessional teams,
inc CPD an attractive place to work service redesign &
improvement high end QI capabilities business operations
management, finance, procurement, facilities, business intelligence
facilities: comprehensive services in the community governance
clinical, financial, organisational
36. www.england.nhs.uk @robertvarnam 3. Design rules for
organisations Personal: culture that values people valuing
deliberately designed systems, teamwork & processes to promote
continuity
38. www.england.nhs.uk @robertvarnam 3. Design rules for
organisations Personal: deliberately designed systems, teamwork
& processes to promote continuity proactive coordinated care
connecting patients with non-medical support using tech to promote
wellbeing, self-care and management known in the community
39. www.england.nhs.uk @robertvarnam 3. Design rules for
organisations Yours: well-designed well-led every GP matters
systems to ensure you flourish
41. www.england.nhs.uk @robertvarnam Strong network /
federation facilitates service development Not all
networks/federations/superpractices are equal GPs dont always like
being led, but leadership is key Evidence from PM Challenge Fund
Huge variety in legal forms, structure, etc no evidence about
superiority for delivering change programme / improved care (but
?other factors, eg economies of scale) Size may matter
42. www.england.nhs.uk Size may matter Category Average time
for full mobilisation % of practices offering weekday extended
hours provision as a result of PMCF (at full mobilisation) % of
practices offering weekend extended hours provision as a result of
PMCF (at full mobilisation) Scope Leadership Small (50) N = 4 8
months 55% 66% More likely integrated with system- wide
transformation Change slower & harder
43. www.england.nhs.uk @robertvarnam Strong network /
federation facilitates service development Not all
networks/federations/superpractices are equal GPs dont always like
being led, but leadership is key Evidence from PM Challenge Fund
Huge variety in legal forms, structure, etc no evidence about
superiority for delivering change programme / improved care (but
?other factors, eg economies of scale) Size may matter Purpose >
function > formPurpose > function > formPurpose >
function > formPurpose > function > form
44. www.england.nhs.uk @robertvarnam Purpose is pivotal but Not
always as clear as people thought Not always as shared as people
thought Often self-centred Most effective when commitment to reach
across boundaries to collaborate in the interests of patients &
population Evidence from PM Challenge Fund
45. www.england.nhs.uk @robertvarnam Deliberate design of:
Purpose Leadership Decision making Service redesign capabilities
Business infrastructure Governance Successful collaborations These
appear important regardless of the form (network / federation /
single organisation)
46. www.england.nhs.uk @robertvarnam How? Where to start?
47. www.england.nhs.uk @robertvarnam How? Where to start?
Release capacity. Now.
48. www.england.nhs.uk @robertvarnam
49. www.england.nhs.uk @robertvarnam Reduce bureaucracy payment
& reconciliation contracts management information flows Reduce
demand increase self help & self management reliable hospital
appointment systems standard local approach to sick notes, etc Work
differently active front end online/phone consultations proactive,
coordinated care + continuity + longer appts enhanced clerical
roles physician associate care navigator Wider primary care at
scale pharmacists physio minor illness nurses social prescribing
welfare rights
50. www.england.nhs.uk @robertvarnam Reduce bureaucracy payment
& reconciliation contracts management information flows Reduce
demand increase self help & self management reliable hospital
appointment systems standard local approach to sick notes, etc Work
differently active front end online/phone consultations proactive,
coordinated care + continuity + longer appts enhanced clerical
roles physician associate care navigator Wider primary care at
scale pharmacists physio minor illness nurses social prescribing
welfare rights
51. www.england.nhs.uk @robertvarnam Reduce bureaucracy payment
& reconciliation contracts management information flows Reduce
demand increase self help & self management reliable hospital
appointment systems standard local approach to sick notes, etc Work
differently active front end online/phone consultations proactive,
coordinated care + continuity + longer appts enhanced clerical
roles physician associate care navigator Wider primary care at
scale pharmacists physio minor illness nurses social prescribing
welfare rights
52. www.england.nhs.uk @robertvarnam Reduce bureaucracy payment
& reconciliation contracts management information flows Reduce
demand increase self help & self management reliable hospital
appointment systems standard local approach to sick notes, etc Work
differently active front end online/phone consultations proactive,
coordinated care + continuity + longer appts enhanced clerical
roles physician associate care navigator Wider primary care at
scale pharmacists physio minor illness nurses social prescribing
welfare rights
53. www.england.nhs.uk @robertvarnam Reduce bureaucracy payment
& reconciliation contracts management information flows Reduce
demand increase self help & self management reliable hospital
appointment systems standard local approach to sick notes, etc Work
differently active front end online/phone consultations proactive,
coordinated care + continuity + longer appts enhanced clerical
roles physician associate care navigator Wider primary care at
scale pharmacists physio minor illness nurses social prescribing
welfare rights