Challenge fund update, Windsor 141125

www.england.nhs.uk

PM Challenge

Fund

update

Dr Robert Varnam

Head of general practice development

[email protected]

Windsor 25.11.14

Video at

vimeo.com/113578615

Password “cumberland”

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Does general practice have a future?

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?

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Why improve access?

• Patient safety

• Efficacy

• Confidence

• Expectations

• Pressure (victims of our success?)

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What do we mean?

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We don’t mean…

bit.ly/GPpolicy2014

Health & wellbeing-promoting care

Responsive access Consistently high quality

Holistic, personalised, proactive, coordinated care

‘Wider primary care, at scale’

www.england.nhs.uk

Patient

System

Team

Professional

What kind of care

do we want people to get?

What approach

would deliver that?

Who should be

involved? How should

they work?

What work should be

done? By whom?

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Responsive access to care

Patients, their families and carers confident that they will get the right

support at the right time, 24/7. It is straightforward to obtain the right

care at the right time from the most appropriate healthcare

professional, through simple and well publicised routes of entry to

care. There is a flexible response to individual needs, through a

greater diversity of consultation types and lengths, including greater

use of telephone, online and video consultations.

Providers make use of a broader skill mix to match staff expertise to

the individual’s need and ability to improve capacity. The barriers

between community-based and hospital-based providers of urgent

and elective care are removed and pathways are improved, to reduce

delays, duplication and gaps in care.

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Patient

System

Team

Professional

What kind of care

do we want people to get?

What approach

would deliver that?

Who should be

involved? How should

they work?

What work should be

done? By whom?

Timely, flexible, ‘right care’

Wider primary at scale. One

patient, one record. Joined-

up commissioning, clear

accountabilities.

Seamless collaboration

across journey. Multi-

professional.

Working to ‘top of skills’.

Supported by system. Able

to pull in other expertise.

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What are people doing?

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100-250k

<100k

>500k

(UK-Wide)

Patients

covered:

Wave one - 254 expressions of interest which

would have served some 35 million patients

but cost £480m

In April 2014, 20 pilots were announced

involving over 1,100 practices and covering

7.5m patients

Po

pu

latio

n c

ove

red

Prime Minister’s Challenge Fund

1. Understand different needs

2. Reshape demand

3. See the whole system

4. Variety of supply

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How to get there?

Health & wellbeing-promoting care

Responsive access Consistently high quality

Holistic, personalised, proactive, coordinated care

‘Wider primary care, at scale’

www.england.nhs.uk

bit.ly/nhs5yfv

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Multispeciality Community Providers (MCPs)

Primary and Acute Care Systems (PACS)

Two specimens

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Multispeciality Community Providers (MCPs)

Two specimens

GP practices

Community nurses

Therapists

Diagnostics

Pharmacy

Dentistry

Specialists

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At-scale primary care?

bit.ly/GP4Ps

PurposePartnerships

Proactivity

Possibility

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Tips for success

www.england.nhs.uk changemodel.nhs.uk

vimeo.com/album/3133652

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Is there a clear purpose for change which is

understood by all participants, and to which all are

committed?

• Is it clear why you’re doing this?

• Does that connect with others’ motivation?

Bring everyone together to agree what you want to

achieve through this programme.

Always include the purpose in communications.

Our shared purpose

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Who needs to be part of this change? How are they

enabled to be collaborators and to take action

themselves?

• Do practices & patients feel like collaborators?

• How to maintain engagement?

Develop initial plans in close collaboration with everyone

who needs to be part of the change.

Engagement to mobilise

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Does everyone you need to lead think of themselves as

a leader? Do they have the right skills and support?

• Leadership ≠ management

• Don’t be a hero

• Time, time, time!

Start including others in your leadership team now.

Budget for leadership time & support.

Leadership for change

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How will innovations be adapted for local use? How

will you rapidly refine innovations before rolling out?

• You’re not that unique – learn from others

• Very few little is plug’n’play

• ‘Iron out’ before ‘roll-out’

Consider where to have a phased approach for piloting.

Spread of innovation

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What improvement methodology(s) will be used to help

redesign and improve systems and processes of care?

How will practices be supported to work smarter, not

just harder?

• Release capacity before anything new

• Ask practices to work smarter not harder

• Build improvement science skills

Ask NHS Improving Quality how improvement tools

could help

Improvement methodology

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What approach will be used for programme planning and delivery? How much management staff time will be needed?

• This is a major large scale change programme.

• Ensure sufficient time.

• Secure the right skills.

• Use proper systems.

Budget for additional management capacity, rather than expecting practice staff to find extra time.

Rigorous delivery

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Are measures being used which will stimulate

curiosity, drive improvement and demonstrate

progress? Are continuous statistical methods used, to

provide realtime feedback?

• Choose a small number of metrics.

• Select metrics in consultation.

• Plan to produce feedback early.

Have a plan and budget for data collection

Transparent measurement

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Patient contact, as a direct result of the change in access

1. The change in hours offered for patient contact;

2. The change in modes of contacts;

3. The utilisation of additional hours offered; and

4. Impact on the ‘out of hours’ service.

Patient experience/satisfaction, including patient choice

5. Satisfaction with access arrangements; and

6. Satisfaction with modes of contact available.

Staff experience/satisfaction

7. Satisfaction with new arrangements

Wider system change.

8. Impact on the wider system attendances

9. Impact on emergency admissions

National metrics

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How does this innovation align with the priorities of

local strategy? Does the environment within which

practices and staff operate make it easy to develop and

implement innovations?

• IT, premises, workforce

• Where to connect/piggy-back?

• What would make this sustainable?

Plan together with commissioners from the outset

System drivers

www.england.nhs.uk changemodel.nhs.uk

Health & wellbeing-promoting care

Responsive access Consistently high quality

Holistic, personalised, proactive, coordinated care

Our Federationvimeo.com/album/3133652