Primary Care FIT FOR 20:20

GP Contract Seminar

DUNCAN MILLER

Programme Manager – More Scottish GP Contract

• NHSScotland– 5.3 million people– £12 billion– 14 Health Boards– 8 Support Boards– Integrated delivery– Moving towards

social care integration

“2020 Vision” Our vision is that by 2020 everyone is

able to live longer healthier lives at home, or in a homely setting.

Integrated health and social care; A focus on prevention, anticipation and

supported self management; Where hospital necessary, day treatment the

norm and focus on getting people back into their home as soon as appropriate, with minimal risk of re-admission.

The Healthcare Quality Strategy for Scotland

Person-Centred - Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making.

Effective - The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

Safe - There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.

Triple Aim Quality Ambitions 12 Priority Areas for Improvement

Person Centered Person Centered Care

Safe Safe Care

Primary Care

Unscheduled and Emergency Care

Integrated Care

Care for Multiple and Chronic Illnesses

Early Years

Health Inequalities

Prevention

Workforce

Innovation

Efficiency and Productivity

Effective

ROUTE MAP TO THE 2020 HEALTH AND SOCIAL CARE VISION FOR SCOTLAND

Health of the Population

Value and Sustainability

Quality of Care

The Importance of Primary Care

The foundation of the NHS:

Over 90% of interactions with healthcare start and finish in primary care.

Key to addressing: Inequalities in health and care; Access to health (and often social) care.

The Challenges Demographic shift to an ageing population Ageing brings a more multi-morbid population (two or more

long term conditions) Worsening health inequalities

This matters because: Living with multiple conditions is the norm rather than the

exception for many people. It is associated with poorer quality of life, more hospital admissions and higher mortality, and significantly worsens the impact of deprivation.

But: We still tend to design healthcare along single disease

pathways

– The majority of over-65s have 2 or more conditions, and the majority of over-75s have 3 or more conditions

– More people have 2 or more conditions than only have 1

Multimorbidity is common in Scotland

There are more people in Scotland with multimorbidity below 65 years than

above

Particularly true in more deprived areas

There are very few generalist hospital services for the under-65s

People living in more deprived areas in Scotland develop multimorbidity 10 years

before those living in the most affluent areas

Primary Care FIT FOR 20:20

PC Strategic Assessments and development plans Assessment of current local provision –

strengths, weakness, interventions; Vision of what needs to be achieved for

20:20; Development Plan - priority areas; Workforce – skill mix and new models of

care.

Primary Care FIT FOR 20:20

New integrated models of care Improve person-centred care; Improved team working around the needs of the

individual; Meets the needs of the locality; Better addresses multiple morbidity; Optimises working relationships across all

sectors.

Primary Care FIT FOR 20:20

Contractual arrangements Development of the more Scottish contract –

impact of the independence referendum; Opportunity for joint working with Community

Pharmacy – Wilson Report/ Prescription for Excellence;

Wider impact of Health and Social Care Integration – GP clusters;

Dental and Optometry.

Primary Care FIT FOR 20:20

Better Primary Care data National GP Information Services; Primary Care data set – variation and

benchmarking; Unscheduled care datamart OOHs performance indicators.

Primary Care FIT FOR 20:20

GMS Contract Agreement in Scotland 2014/15• 264 points retired, with funding transferred to GS• 151 points from clinical QOF, 80 points from

disease registers and 33 points from patient experience

• For clinical changes – expectation is that GP practices continue to provide care that is clinically appropriate

• Return to 15 month review cycle

Primary Care FIT FOR 20:20

GMS Contract Agreement in Scotland 2014/15• New patients still be to coded at diagnosis and

provide clinically appropriate lifestyle advice• New Quality and Safety Domain

oNominated liaison GP for H&S integrationoReview of AccessoContinuous Quality Improvemento ACPs continue – annual report/ SEA ceaseo Patient Safety

Primary Care FIT FOR 20:20

GMS Contract Agreement in Scotland 2014/15• Publishing GP Earnings – greater transparency• Support the development of a Scottish GP

Contract over the next 3 years• Important role of GPs in the development of

Health and Social Care Integration• Impact of caring for elderly population, and

patients in deprived and rural areas• Recruitment and retention – Golden Hellos,

Seniority

Primary Care FIT FOR 20:20

Scottish GMS Contract Arrangements 2014 -2017• No planned major change to QOF – will be kept under

review by SG/ SGPC• NICE recommendations out – Diabetes Bundling,

Hypertension and AF changes – still under consideration• Work with SGPC to develop a Scottish GMS Contract

from 2017 onwards to support 2020 vision for Health and Social care

Primary Care FIT FOR 20:20

Scottish GMS Contract Arrangements 2014 -2017• Golden Hellos

o Remove automatic entitlement: focus on remote, rural and deprived areas

o greater flexibility on paymento Support for appraisal for sessional locum GPso Support for GP Returners

• Publication of GP NHS Net Earnings – develop ‘model’ report on GP Practice data held at Practitioner Services Division

Primary Care FIT FOR 20:20

Scottish GMS Contract Arrangements 2014 -2017• Seniority Payments

o £18m currently spent across Scotland o Review of current programme to consider how best to deploy

this resource to support the sustainability of general practice in Scotland

• Others important areaso Review of the Scottish Allocation Formula – financial framework

to support the Scottish GMS Contract going forwardo Review of variability of funding to ensure funding supports

general practice across Scotland but addresses inequityo Review of immunisations

Primary Care FIT FOR 20:20

Scottish GMS Contract Arrangements 2014 -2017• Others important areas (continued)

o Work with emerging Health and Social Integration Authorities to ensure general practice plays leadership/ integral role in the development of locality planning arrangements

o Work with the programme supporting the implementation of Prescription for Excellence

• Others contractual areaso GP workloado Infrastructure (GP Premises and IT)o Enhanced Serviceso Recruitment and Retention

Primary Care FIT FOR 20:20

Questions/discussion