Hugh Reeve: Transforming Primary Care in Cumbria

Health Policy Summit

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Transforming Primary Care in Cumbria

82 Practices

List sizes:

750 – 20,000

The task of primary care: • Population based care - improving the health

of the local population • Unplanned care – for acute illness and crises

in people with ongoing problems • Planned care – ‘one off’ or ‘on and off’ issues • Ongoing care - for people with LTCs (physical

and psychological), cancer, multi-system problems

• End of life care

“Every system is perfectly designed to deliver the results it gets”

Dual Challenge: Transformation of general practice • Internal systems and processes

– Access, paper and electronic communications, medicines management, LTC management systems, etc

• Clinical capacity – Workforce mix and clinical skills capabilities

Integration with other health and social care teams • Information flows - Chinese walls • Different business models

– Independent contractors, FTs, Social Enterprises, Social Care, private and third sector providers

• Commissioning responsibilities and funding flows

Independent, super heroes

Teams, delivering joined up care

A new paradigm • Moving from the current reactive approach to

planned, proactive anticipatory care • Health giving relationships and supporting self

management – allowing people to take control, co-production of their health with ‘professionals’

• Access to the right clinician - face to face IF you need to see a clinician, otherwise by phone or on-line ‘Call, click or come-in’

• Learning from the best from elsewhere in the “service sector” – patient not organisation centred care

Cumbria’s “Common Platform”

Infrastructure Appropriate buildings; Integrated electronic

record; Common templates Directory of services (statutory and non-

statutory); Performance feedback;

.

EHR

GP and Community Teams

EMIS Data Repository Path Lab

Radiology Minor Injury Unit Hospital

Central Support Team

Specialist Clinics

EMIS Web Portal

EMIS Web Portal

PatientInfo Data

PatientInfo

EHREHR

EHREHREHR

EHR

RxRx

Hospital Info

Reports

Guidelines

PatientInfo

PatientInfo

Reports

Guidelines

PatientInfo

LabResults

RadiologyReport

RadiologyReport

LabResults

Integrated Information: glue that holds it all together

Pharmacy

Referral

ALERT

ReferralALERTALERT ALERT

ALERTData Streaming between local

centres and

Workforce Workforce planning;

Training and education; Multidisciplinary Teams with

appropriate skills and competencies;

Mobilised Community assets .

Infrastructure Appropriate buildings; Integrated electronic

record; Common templates Directory of services (statutory and non-

statutory); Performance feedback;

.

Cumbria’s “Common Platform”

Workforce Workforce planning;

Training and education; Multidisciplinary Teams with

appropriate skills and competencies;

Mobilised Community assets .

Outcomes Supported self management;

Reduced mortality; Reduced morbidity;

Improved quality of life; Improved experience for patients, carers and staff; Improved cost efficiency.

Infrastructure Appropriate buildings; Integrated electronic

record; Common templates Directory of services (statutory and non-

statutory); Performance feedback.

Cumbria’s “Common Platform”

Workforce Workforce planning;

Training and education; Multidisciplinary Teams with

appropriate skills and competencies;

Mobilised Community assets .

Outcomes Supported self management;

Reduced mortality; Reduced morbidity;

Improved quality of life; Improved experience for patients, carers and staff; Improved cost efficiency.

Infrastructure Appropriate buildings; Integrated electronic

record; Common templates Directory of services (statutory and non-

statutory); Performance feedback.

Cumbria Learning and Improvement Collaborative Providing the capacity for delivering change across Cumbria Joint ownership – CCG, Provider Trusts and Local Authority

Cumbria’s “Common Platform”

Individuals and Families

Community Assets

Built around GP populations 15,000 – 50,000

NHS Community Providers

Pharmacy Dentist

Optometry

Specialist Teams

Specialist Teams

Social Care Providers

Non-traditional Providers

GP Practice

GP Practice

Workforce Workforce planning;

Training and education; Multidisciplinary Teams with

appropriate skills and competencies; Mobilised Community assets .

Outcomes Supported self management;

Reduced mortality; Reduced morbidity;

Improved quality of life; Improved experience for patients, carers and staff; Improved cost efficiency.

Infrastructure Risk stratification system; Care planning process;

Integrated electronic record; Directory of services

(statutory and non-statutory); Performance feedback; Appropriate buildings.

Cumbria’s “Common Platform”

Individuals and Families

Community Assets

Built around GP populations 15,000 – 50,000

NHS Community Providers

Pharmacy Dentist

Optometry

Specialist Teams

Specialist Teams

Social Care Providers

Non-traditional Providers

GP Practice

GP Practice

Cumbria Learning and Improvement Collaborative

CCG “INSURER”

Carlisle

Eden

Furness South Lakeland

Allerdale

Copeland

A central Commissioner with a network of Primary Care Provider Groups

Primary Care Communities

Some Key Issues

• A new Business Model - moving from the corner shop to larger groups – SPAR Local or Tesco Local

• Partnership between CCG, LAT and local providers to facilitate this

• Contractual mechanisms – GMS v APMS v ?? – Alternative Quality contract, Lead Provider, Alliance

• Conflict for CCG in increasing investment into primary care – air cover from H&WBB + LAT/NCB