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@robertvarnam
The future of general practice
Dr Robert Varnam@robertvarnam
bit.ly/161102rcgp
@robertvarnam
One of the things motivating me as I first looked outside the walls of our practice, to lead some local service redesign for diabetes, was fear. A fear that general practice, despite being a service depended on by the country, had a very uncertain future.
In fact, I was afraid that general practice was being run into the ground. Although NHS spending was rising, with growing amounts of staff and money, the majority was going elsewhere in the system. Even though we were talking increasingly about the importance of providing more care outside hospital, the investment was going inside hospital.
Does general practice have a future?
@robertvarnam
So why are people talking about change? It’s partly about the pressure we’re under right now, and partly about the huge opportunity to do something better. And, for once, the same changes that would help with one are also necessary for the other. Pressure Opportunity
@robertvarnam
UK general practice is one of the world’s most comprehensive embodiments of the founding principles of primary care…
Personal care built on a relationship from cradle to grave
Community based responsible for prevention and care of a registered population
Holistic perspective understanding the whole patient not just a disease
Comprehensive skills to diagnose & manage almost anything
Personal and population-orientated primary care is central … if general practice fails, the whole NHS fails. Simon Stevens, General Practice Forward View
@robertvarnam
Specialists
Non-specialist / failed consultantGatekeeper / door-holderKing of my castleIt’s all in me
Community services
@robertvarnam
Community services
Specialists
Non-specialist / failed consultantGatekeeper / door-holderKing of my castleIt’s all in me
Excellent continuity (by default)
The GP is there for everything
Complex care often disjointedGPs professionally isolated and undervaluedThe GP is there for everythingBiopsychosocial needs often met in medical wayOverdiagnosis & overtreatment
GPs & patients have been imprisoned within the walls of a castle that is too small.
@robertvarnam
Improving access
“Right access 2016”
@robertvarnam
@robertvarnam
@robertvarnam
@robertvarnam
@robertvarnam
@robertvarnam
Collaborative working Whole system approach Self-care Broader workforce Tech
bit.ly/GPAFresources
@robertvarnam
We’re a federation.
So… ?Dr Robert VarnamHead of General Practice
Development@robertvarnam
#GPForwardView
@robertvarnam
What size ? What structure & legal entity?
We’re a federation. What now?
Prime Minister’s GP Access Fund: 2,500 practices
New care models vanguards: 1,023 practices
@robertvarnam
Clarity
Commitment
Agility
Alignment
Priorities
Partnerships
4 400
We need the best of both worlds
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@robertvarnam
What size ? What structure & legal entity?
We’re a federation. What now?
@robertvarnam
Association
Network
Federation
Partnership
Superpractice
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Whitstable medical practice
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AT Medics, London
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• staff pooling• shared training• common policies &
procedures• new specialist input
e.g. Wakefield, S Cotswolds, Richmond
@robertvarnam
What size ? What structure & legal entity?
We’re a federation. What now??
@robertvarnam
Purpose > function > form Purpose > function > form Purpose > function > form Purpose > function > form Purpose > function > form Purpose > function > form Purpose > function > form Purpose > function > form
@robertvarnam
What shall we achieve?Who is ‘us’?
What capabilities will we need?
What ways of working will
serve us best?
How should we lead?
What infrastructure
will support us?
@robertvarnam
Leadership
Creating shared purpose
Strategic planning &
partnerships
Leading through change
Being a leader
Improvement
Patients as partners
Process design
Using data for improvement
Rapid cycle change
Business
Team leadership
Operations management
H R
I T
At-scale working
Governance
Contracts
Workforce
Business intelligence
Capabilities for the future
Interdependent capabilities for leaders & organisations
@robertvarnam
Pick something to achieve
Do it together
Build relationships & capabilities as you go
Build structures & contracts to sustain new things
So …?
Leadership
Creating shared purpose
Strategic planning &
partnerships
Leading through change
Being a leader
Improvement
Patients as partners
Process design
Using data for improvement
Rapid cycle change
Business
Team leadership
Operations management
H R
I T
At-scale working
Governance
Contracts
Workforce
Business intelligence
General practice capability framework
Interdependent capabilities for leaders & organisations
@robertvarnam
Workload
o Urgent help
o Reduce it
o Manage it
@robertvarnam
Vulnerable practice schemePractice resilience programme
• Flexible approach• Rapid help AND sustainable solutions
• beyond short-term ‘gap-filling’• Looking beyond individual practice
@robertvarnam#GPforwardview
Simplify reporting and regulationStreamline payment systemsMove away from micro-incentives
Greater specialist support
Self-help and GP Online
Better sign posting• Care navigation• Social prescribing• Minor ailments• Remote triage/care• Open access AHPs
Reformed 111/Urgent Care
Collectiveworking and MCP contract
GP PRACTICE
Community services
Changes to
Standard Contract
HOSPITAL
Access hub
Demand Management
@robertvarnamTypical practice 6,700 patients [email protected]
@robertvarnam#GPforwardviewwww.england.nhs.uk/gpdp
@robertvarnam#GPforwardviewwww.england.nhs.uk/gpdp
Local Time for Care programmes• Bespoke 9-12 month
programme to support a group of practices to implement innovations that release time for care.
• Training for reception and clerical staff, for active signposting and document management (£45m over 5 years).
• Funding towards purchasing online consultation systems (£45m over 4 years, from 2017).
• CCG transformational support (£171m over 2 years, from 2017).
General Practice Improvement Leaders• At least 400 free places a
year for three years.
• Skills and confidence in designing and implementing improvements within the practice rapidly and sustainably.
• RCGP Supporting Federations Network and NHS Collaborate (NAPC & NHS Alliance) for leaders of at-scale primary care.
• Funding facilitated peer networking for practice managers of all 7,800 practices, with support to develop professional skills.
• 24 regional GPFV roadshows• 30 local High Impact Actions
showcase events• Web resources (60 and
growing)• Fortnightly webinars• Network of champions
10 High Impact Actions to release time for care
@robertvarnam
10 High Impact Actions
@robertvarnam
10 High Impact Actions
@robertvarnam
10 High Impact Actions
bit.ly/gpcapacityforum
@robertvarnam#GPforwardview
• Bespoke 9-12 month programmes to support groups of practices to implement innovations that release time for care.
• Open to all 7,800 practices in England. Registrations received from practices in 35% of CCGs in first 3 months. Expected total of 200 local programmes to run over three years.
• Evidence indicates most practices can expect to release 10% of GP time through programme.
• Each programme designed to align with existing local initiatives.
www.england.nhs.uk/gpdp
Time for Carechange programmes
Can be aligned with new transformational funding:• Training for reception and clerical staff, for active signposting
and document management (£45m over 5 years).
• Funding towards purchasing online consultation systems (£45m over 4 years, from 2017).
• CCG transformational support (£171m over 2 years, from 2017).
@robertvarnam#GPforwardview
General Practice Improvement Leaders programme• Training for clinicians and managers in service
redesign and change leadership. Creating at least 400 free places a year for three years.
• Focus on techniques for designing and implementing improvements within the practice rapidly and sustainably.
• Learn-while-doing approach gives immediate as well as longer term benefits..
Fundamentals of change and improvement (2-day session)
Human dimensions of change (2 x 1-day sessions)
Facilitation skills (2 x 1-day sessions)
Primary care improvement community
Learn-while-doing
• Funding the RCGP Supporting Federations Network. 750+ members, 3 national events a year, 6 webinars, growing library of online resources.
• Funding NHS Collaborate (NAPC & NHS Alliance) network for leaders of at-scale primary care. Bi-monthly face-to-face networking, aiming to grow to 200 members in next year.
• Funding facilitated peer networking for managers of all 7,800 practices, with support to develop professional skills.
www.england.nhs.uk/gpdp
@robertvarnam
Self Care
Broader skillmix
Self management /
social prescribing
Emergencycare
Collaborationwith specialists
At scale
Population wellbeing management and holistic person-centred care provided by a multiprofessional team led by the GP, supported by at-scale collaboration and efficiencies.
@robertvarnam
Self Care
Broader skillmix
Self management /
social prescribing
Emergencycare
Collaborationwith specialists
At scale
Population wellbeing management and holistic person-centred care provided by a multiprofessional team led by the GP, supported by at-scale collaboration and efficiencies.
A model of care no longer solely defined by or limited to the contribution of the GP
Continuity (by design)Extended team provides joined-up comprehensive carePartnership working with patient & community
Big redesign journeyChange needed across whole systemNew capabilities neededLoss of some aspects of professional identity (for
some GP partners)
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@robertvarnam
Innovators are here(already)
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@robertvarnam@robertvarnam
AppropriatenessPotential
@robertvarnam@robertvarnam
AppropriatenessPotential
CapabilityCapacity
@robertvarnam
The future of general practice
Dr Robert Varnam@robertvarnam
bit.ly/161102rcgp
