5 Year Forward view and what it means for General Practice Dr Helen Mead FRCGP Vice Chair & Council Representative Leicester Faculty RCGP
Aug 15, 2015
5 Year Forward view and what it means for General Practice
Dr Helen Mead FRCGPVice Chair & Council RepresentativeLeicester Faculty RCGP
• Thanks to Dr Tim Ballard Vice Chair RCGP for slides
• I also work for Health Education East Midlands (HEEM), a part of Health Education England (HEE). Any views expressed here, while informed by this work, are my own and not the view of HEE or HEEM
Acknowledgements & disclaimer
Where are we starting from?
1. 10 years under-investment in general practice
2. Failure to develop the workforce in general practice
3. The Five year Forward View – Building the New Deal
4. Building the workforce – the 10 point plan
English General Practice
today
• Around 1.2m patients seen every working day
• 340-370 million consultations per year (300m in 2008)
• Increase in workload, static funding and falling resource is bringing general practice to its knees
General practice funding has fallen by 8% across Britain in real terms since 2005/06 – at a time when the rest of the NHS budget has grown by 18%
Source: RCGP analysis
Rising Demand Between 1995 and 2008, the number of consultations in General Practice rose by 75% to more than 300m. A sharp increase in consultations for those over 65 has contributed to this
https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
• “a collaborative vision which describes the blueprint for the future of the NHS. It was published as a critical intervention after the political party conferences but before the publication of manifestos, to ensure that the voice of the NHS is heard”
Adlington K, Finn R, Ghafur S, Smith CR, Zarkali A
On behalf of the FMLM National Medical Director’s Clinical Fellows 2014-15
What is it?
• “NHS will take decisive steps to break down the barriers in how care is provided”– Primary and secondary care– Physical and mental health– Health and social care– Support for patients with multiple health
conditions not single diseases
Five Year Forward View
• “radical upgrade in prevention and public health”– NHS will back hard hitting national campaigns
• “patients will gain far greater control of their own care”– Including shared health and care budgets
Five Year Forward View
• “England is too diverse for a ‘one size fits all’”– But we must not let “a thousand flowers bloom”
Five Year Forward View
• Other underlying principles– Integration of OOH/emergency services– New models to allow smaller hospital to remain
viable– Midwifery led services– More care for those in Care Homes– Continuation of list based Primary Care– Ability to flex terms and conditions locally– More technology
Five Year Forward View
In principle• Care designed round the needs of the
patient rather than the needs of the system
• The Coalition of Collaborative Care
What does this actually mean?
• In practice• Refocus on prevention
– General/targeted/employment/workplace health– Locally led & driven e.g. DevoManc
• Empowering patients– Access to care records– Group based education (with voluntary sector)– Increased patient choice
What does this actually mean?
• Engaging communities– Supporting carers– Encouraging volunteers– Stronger partnerships with 3rd sector– The NHS as an employer
What does this actually mean?
• Exploring new ways of working– Multispecialty Community Providers
• a multidisciplinary team of clinicians from both primary and secondary care, GP, outpatient and ambulatory care services
– Primary and Acute Care systems• Fully integrated primary and secondary care, via a
single provider for GP, hospital, community and mental health services.
What does this actually mean?
• Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations, Networks and Federations
• Why are Federations & Networks part of the answer?
• Enable Professional Control• Keep the traditional patient facing feel of GP• Demonstrate the will to tackle variability• Control Segmentation• Control the way we work with Secondary Care
• For you– Networks and Federations– More work – More connections– Need for a different workforce– Risk of a competitive marketplace for personnel– Increasing privatization/3rd “sectorization”
What does this actually mean?
• For you– Networks and Federations
• Herding cats• Skill sets
– More work • Moving care from secondary to primary care• Prevention initiatives• Co-ordination
– More connections• Direct working with trusts, 3rd sector, home care
What are the specific challenges?
• For you– Need for a (different) workforce
• Workforce planning• GP recruitment/retention crisis• Need for clinical leadership
– Risk of a competitive marketplace• Local variation in terms & conditions
– Increasing privatization/3rd “sectorization”
Challenges ?
• Federate & Network – engage locally• Use Co-Commissioning• The Whole systems Integrated Care
Toolkit• Building the workforce – the new deal for g
eneral practice• Making time to keep in touch
Potential “solutions”
The Future?
Progress is impossible without change, and those who cannot change their minds cannot change anything
George Bernard Shaw