Michael Dillon Presentation

Bury GP Federation

Delivering Primary Care at Scale

General Practice Management - 4th June 2015

Bury – Greater Manchester

24 June 2015 Bury GP Federation

• 200,000 population• 33 GP practices• 3 large Primary Care

Centres• Surrounded by acute

hospitals

PMCF : Easy-GP Summary

Building on the services and experience from Healthier Radcliffe Pilot (Ph1)Easy GP Programme is founded on the following principles:• Right care at the right time for patients at a place convenient to them• Provide services that better value patients time• Offer patients greater freedom to exercise control when interacting with

General Practice• Ensuring Patients have the information they want to make better choices

about GP services

4 June 2015 Bury GP Federation 3

200,000 registered patients12 month programme

6 month service period £3M funding30 of 33 GP Practices

Extended Working HoursLonger opening hours including :• Extended weekday opening (8am

to 8pm), and• Saturdays and Sundays (8am to

6pm)– All services available locally but not in

every GP practice– Every patient’s notes available to GP

providing cover during extended hours– Reducing likelihood of people needing to

go to hospital– Making it easier for those who work or

have school age children to avoid disrupting their working/school day

– Easier for families to attend with elderly relatives

Telephone Consultations


Easy GP Projects (1)

Ensure that all patients who request an appointment are offered the option of a telephone consultation:

– Currently about 35% of practices offer telephone consultation to patients

– We believe that such consultations can be a better use of GP and patient time

– Patients are often capable of knowing whether they need to see the clinician face-to-face

– A higher proportion of telephone consultations would release GP time and reduce waiting times for appointments

1 2

Increased Online AccessIncrease use of online services from current 4% of patients to 60%+:

– Currently patients who register can make appointments or re-order prescriptions using online

– All practices in Bury are enabled for online access

– Registration is a difficult process which is not user friendly – we plan to change this significantly and offer help to patients to register and use online services

– More services should be available to patients over time including them having access to their own health records and the ability to ‘email’ their GP.

– Increasing registration will significantly widen access

GP Comparison Website


Easy GP Projects (2)

Develop a “GP-Comparison” website to enable patients to make better choices about GP services:

– Current websites offer limited information to patients

– This website would offer information in a detailed and searchable form, modelled on successful comparison-style sites used elsewhere

– The website would enable patients to search for staff availability, service availability, staff expertise etc and would show information for all relevant practices in Bury

3 4

• The service model was developed collaboratively with input from all member practices. • Defined a number of ‘design principles’ which influenced the nature of the service:

– Designed to offer 1,425 GP EWH appointments per week (85 min/week/1000)– The service is delivered from 5 local GP practice locations– All patients registered with a Bury GP are able to access appointments at any of

the five sites.– EWH GPs have read and write access to the patient’s GP record. – Delivered by over 30 local GPs and up to 20 local admin/support staff. – Designed to be sustainable, both in terms of sharing the demand placed on the GP

workforce (no obligation on individual GPs) and build the platform to meet the future needs of local patients.

– Appointments are accessed through the patients’ own practices as ‘an extension’ of the primary care service offered by their GP practice

– Aims to use a consistent core staff base (preferably from within member practices) to provide continuity and consistency in the service and to make it a familiar experience for patients.

Designing the Bury EWH service


Establishing the EWH service

PROPOSED SESSIONS & CLINICS

General Practice consultations** (Initial Priority)Asthma clinics

Chronic obstructive airways disease

clinicsCoronary heart disease clinics

Diabetes clinics

Hypertension Monitoring

Services? Capacity? Delivery Model?



Pilot success measures – EWH service

EWH Appointments – Provision and Utilisation (to 24th May)

Explanations & Observations• Increasing capacity in line with demand• Impact of prescription printing• Generally highly utilised• Low DNA rates (normally)• Awareness & reliability = utilisation• GPs – Weekday evenings less popular

…Patients prepared to travel…Patients happy to see an unfamiliar GP…Patients value evening & weekend access


System impact and re-commissioning

Anecdotal evidence….Patient Exit Poll!!

PMCF system level evaluation of the pilot and impact• Data linking issues• Isolating the cause & effect• Source of sustainability funding …Patients want to see a GP outside core hours (challenge for commissioners!)


Telephone Consultations

Appointments per week per 1,000 patients

• +1/wk = 200 extra choosing TC

All Bury practices (200k reg. patients)

‘Champion’ practice (10k reg. patients)

…..a lot to investigate/evaluate!

• +12/wk = 120 extra choosing TC

• 869 extra TCs per month

• …92,000 appointments in month

• 0.94% more patients choosing TC

• 521 extra TCs per month

• …2,500 appointments in month

• 21% more patients choosing TC

Primary Care at Scale - Learnings

PMCFLearnings

Designing for sustainability• The right system design will take time…..resist pressure to ‘just do’• Design against a single, stable outcome….capacity? convenience? deflection?

Engaging practices to create ownership and commitment• Expectation that answer is ‘pre-determined’ elsewhere• Dispel myths that every practice/clinician has to offer extended hours • ‘Target Capacity’ (best supported ‘guess’)…commissioners prefer practice consensus

Integrating all initiatives/projects• Aligned and contributing?……or risk losing scope/services• New approaches probably means getting the infrastructure will be difficult

Contracting & performance managing• Single system of ‘sub-contractors’……internal before external• Expectations change from Pilot, through ‘Scaling’ to ‘Commissioned’

Evaluating the impact• Many expectations……link to the ‘design’ outcome• Data collection in Primary Care: Multiple, non-standardised sources of data

Implementing the services• Dedicated resources & costs - scale not achieved through practice ‘spare capacity’• Retain flexibility of the service & delivery pace as long as possible (mitigates risks)• Using incentives to overcome initial inertia (…..linked back to outcome)

Developing the organisation & increasing capacity (as a Federated provider)• Rapid development of organisation’s processes, capacity & capability• Growth brings challenges for organisation’s sustainability (more revenue to support operating

costs, more costs to increase revenue)

Ghost (signpost) – current chapter title...

Bury GP Federation4 June 2015 11

How does this help General Practice?

• Pilot…….means we may prove that some things don’t work!• Federating & large scale delivery?

– Offers full coverage & standard offer to all patients– Shared not individual responsibility for service delivery responsibility– Reduced contracting and performance management effort/cost

• Reduced risk/shared benefit for practices?– Those not able to provide are supported by those that can– All shareholders benefit from contract ‘surplus’– Those practices providing ‘earn’ extra income– Limited risk to any single practice…..everyone wins??

• Workforce?– Resilience through larger resource pool– GPs value working with different colleagues

• Role of Technology?– Value offered tech needs to be enhanced and clearer– Channel expected by patients….. rather than tranformational


Bury GP Federation

[email protected]

Healthcare

Michael Dillon Presentation