Future of General Practice Delivery in North Tyneside Dr George Rae Chief Exec. Newcastle & N Tyneside LMC GPC Member BMA Council Member Dr Ken Megson.

Future of General Practice Delivery in North Tyneside

Dr George RaeChief Exec. Newcastle & N Tyneside LMC

GPC MemberBMA Council Member

Dr Ken MegsonExec. Officer Newcastle & N Tyneside LMC

Hon. Sec. Gateshead & S Tyneside LMCHon. Sec. North East & Cumbria Regional LMC

ContextGeneral Practice on cusp of most radical change

since NHS inceptionIn N Tyneside we are reacting within a very short

timescale due to CCG deficit (£17m?)As your representative committee, the LMC will

play its part to ensure the best deal for your future contract and delivery of care – also best deal for patients

ContextMany questions to be asked and answeredTwo issues running concurrentlyIntertwined with each otherWill define our future

Two Concurrent IssuesNew “voluntary” GP contractNew models of care- Five Year Forward Review –

Simon Stevens

New GP ContractTo support doctors to deliver 7-day services and

integrate careAll patients to have access to 7-day GP care by 2020Cameron- contract to get rid of box ticking and form

fillingMicromanagement of GP’s work through QoF and

other sorts of old fashioned bureaucracy to be scrapped

New voluntary contract integrated with community nurses and other healthcare professionals

New Contract -Key Principles

More money for primary careMore control over the way GPs workMore time to care for patients AND services 7

days a week!

New ContractCameron – “patient guarantee”Government will mandate NHSE and CCGs to

ensure that every patient has access to 7-day services by 2020

By April 2017 the new contract will be offered that recognises the OUTCOMES that GPs and colleagues offer to patients, including 7-day services

The new contract will be voluntary. With FEDERATIONS or practices that cover populations of at least 30,000 patients

New ContractUnderpinned by a strong economy and £10

billion of investment in the NHSNorthumbria Trust mentioned a lot by Cameron

and Hunt in 7-day services and new models of care!!

New Models of CareSimon Stevens Five Year Forward ViewTo dissolve traditional boundaries between general

practice, health and social care and mental health services

Multi-speciality Community Providers (MCPs)- forming extended primary care group practices through federations, networks or single organisations to provide a wide range of care using a broader range of professionals e.g. employing consultants or taking them on as partners

New Models of CarePrimary and Acute Care Systems (PACS) – a new

variant of vertically integrated care allowing single organisations to provide GP, hospital, community and mental health services

Urgent and emergency care networksEnhanced care in care homes

Development of contracting under MCPs, PACS and ACOs

A) GPs RUNNING THE ORGANISATIONGPs themselves, through a federation or super

practice form the basis of an MCP providing a wider range of services to a registered population

The network could start by providing extended access and enhanced services but move on to provide community services and eventually sub-contract or provide secondary care services, this becoming an ACO

Development of contracting under MCPs, PACS and ACOs

B) PACS TYPE OF ORGANISATION OR LOOSE ACOTo develop new integrated models CCGs would

closely align incentives between primary acre and other parts of the health economy

Scope within this model for development of significant role for GP federations- become the contract holder for range of primary care services

General practice might remain largely unchanged in this model

Development of contracting under MCPs, PACS and ACOs

C) ACO HOLDS CONTRACT FOR ALL POPULATION CARE INCLUDING GP SERVICESNot recognisably based on GP led organisationsMore likely to grow out of Foundation Trust

based PACSThe ACO would have an effect on your

contractual status

Contractual Options under ACO

The ACO could:a) Sub-contract GP provision to individual

practices, using a lead provider as contractorb) Run local practices directlyc) Employ GPs to provide primary cared) Bring GPs in as shareholders/partners with

implications for risk share/gainse) Use a combination of methods a), b) and c)

Key Issues National/core contract, nGMS, PMS, APMS Robust federation imperative Must be GP led Pensions Lead provider, management Salaried service increase Adequate, appropriate consideration time imperative Job security How quickly and how much debt will be saved by ACO

Dr Ken Megson

Exec. Officer Newcastle & N Tyneside LMCHon. Sec. Gateshead & S Tyneside LMC

Hon. Sec. North East & Cumbria Regional LMC

ContextNeed to changeImprove integrated careCCGs leading on changeCCG in financial deficitACO a proposed modelTTIP

Proposed ACO ModelBoard of providersLead providerOther providers subcontracted to leadCCG

ACO BoardMembershipLegal standingBalance of powerHolds budgetHas GMS contracts

Lead ProviderWill be a FTWhat will they provideDay to day managementHolds GP contract

GP ContractsGMS – who with?Subcontracts – who with, securityEnhanced servicesRelationships – ACO, federation, lead provider,

CCG, NHSE

What we want out of tonight?

Raise awarenessCollate questions that need answersSlow the process downLook at alternatives –Plan BPractices to remain unitedNeed promise of individual voteJust the beginning of the process

Questions & Answers