Achieving vertical and horizontal

integration: working with partners across

primary, community, social and secondary

care to provide a better level of service to

patients

Sarb Basi, Managing Director,

Vitality Partnership

Realising the potential of primary care

Current Political Context

• Managing Long Term Conditions

• Reducing demand on hospital care (urgent care)

• Shift of care into community settings

• Increased demand for primary care

• Better value from GP contract

• Focus on ‘demonstrating quality’

• NHSE/CCG/PH commissioning intentions

Drivers for change

• Need for greater GP involvement in driving better care…

but can’t wait for commissioning led innovation

• Fragmented general practice infrastructure a barrier to

reducing hospital activity and service redesign

• Poor quality primary care remained largely unchallenged

by commissioners

• CQC will start shutting down poor general practice

• Current GP model unsustainable: economics,

demographics

• Transformation of non-clinical and clinical capabilities is

overdue

Future of Primary Care

• The patient voice at the heart of all provision

• General practice should be the ‘locus of community based

integrated services at scale’

• Specialist expertise is an essential component

of effective integration

• Integrated services to incorporate social care

• Technology is an enabler to manage demand

GP partnerships will be gone in ten

years, says NHS England official

Dr Mike BewickHe also said that he expects each new

provider model to accommodate around

300,000 patients - similar to CCGs

the current organisational structure of

primary care is no longer ‘sustainable’ or

‘desirable’

10 September 2014

Andy Burnham: Why general practice

should move towards a salaried model Shadow health secretary Andy Burnham talks

exclusively to Pulse about why GPs should be

predominantly employed by large health and

social care organisations

17 September 2014

Practice closures set to widen GP

privatisation All new GP contracts will be thrown out to

private providers under APMS, in a move

described as the ‘death knell’ for traditional

practice

09 September 2014

Practice hands contract back after four

partners are forced to resignFour partners in a practice in a deprived area

have been forced to take the decision to resign

and hand back their contract to NHS England

due to problems recruiting partners.

15 September 2014

All quiet on the western front

GP Provider led innovation

• GPs need to lead and own the transformation of General

Practice

• Do not wait for policy or national direction

• The status quo is not an option so lead or work with other

innovators

• Future proof the professional with a proactive and

progressive model NOT from a protectionist approach

• Embrace the future landscape and opportunity to provide

at scale

• Think differently – there is no limit to the possibilities

• Partner with like minded NHS providers

Traditional Practice Model Federations ‘Super Partnerships’

(Sole trader, multi-partners)

Full

Merger/IntegrationCollaborationConsultation

2k – 15k patients 30k – 500k patients 80k + patients

Emerging Models in General

Practice

Size Matters

•District Nurses

•Health Visitors

•Physiotherapists

•Case Managers

•GP practices

•Pharmacy

•Dentist

•Optometrist

•Social Workers

•Health & Well Being

•3rd Sector

•Specialist Services

• Intermediate care

•Mental Health Workers

Secondary Social

CommunityPrimary

Vitality PartnershipVitality Birmingham

• 2009 26k

• 2010 32k

• 2011 38k

• 2012 40k

• 2013 58k

• 2014 68k+

• 2015 150k+

(CCG, 550k)

Vitality Walsall

Vitality Leicester

Vitality London

• 10 mergers

• 21 partners

+ 3 associate

+ 2 fixed share

• 5 PMS and 4 GMS contracts

• £12m+ turnover

• 250+ staff

• NHS specialist services

• Private services

• 13 primary care sites (plus

university sites)

• Integrated IT: EMIS Web across

all sites (except one)

Integrated/Additional Services

• Rheumatology

• Dermatology

• Orthopaedics

• Immunology

• Substance Misuse

• X-ray

• Zero Tolerance

• Physiotherapy

• Podiatry

• Osteopathy

•ENT

•Urology

•Gynaecology

•District Nurses

•Intermediate Care

•Healthy Communities

Collaborative

•Pain Services

•Private Services

Our Horizontal Integration

• Acute and Community Strategic partnerships

• Health and wellbeing services

• Social Care

• Mental health

• Public Health and population management

• 3rd Sector

Vitality Partnership

Innovative Organisational

Dynamic

Provision at scale

Primary Care Demand (1)0

12

34

56

Num

ber o

f con

sulta

tions

per

per

son-

year

19951996

19971998

19992000

20012002

20032004

20052006

20072008

NOTE: Analysis by calendar years

copyright QRESEARCH 2003-2009 (Database version 22)

All clinicians and all locations (England)

QRESEARCH crude consultation rates per person-year

Primary Care Demand (2)0

510

15

Num

ber o

f con

sulta

tions

per

per

son

-yea

r

0-4 y

ears

5-9 y

ears

10-14 y

ears

15-19 y

ears

20-24 y

ears

25-29 y

ears

30-34 y

ears

35-39 y

ears

40-44 y

ears

45-49 y

ears

50-54 y

ears

55-59 y

ears

60-64 y

ears

65-69 y

ears

70-74 y

ears

75-79 y

ears

80-84 y

ears

85-89 y

ears

90+ years

Age band

Males Females

NOTE: Analysis by calendar years

copyright QRESEARCH 2003-2009 (Database version 22)

All clinicians and all locations (England)

QRESEARCH crude consultation rates per person-year in 2008

Digital Vitality – Our Consumers

• 82% of UK population

using broadband to

transact…

• <1% of patients using

the internet to interact

with clinicians!

• Birmingham has

highest penetration of

smartphone use in the

U.K….nearly 30%

more than London..

We have the population

and capability to shift the

balanace of provision to

the web!

Digital Vitality

Digitally enabled transformation of healthcare is not about

systems, data, technology, analytics….or any of the usual

NHS IT/Informatics stuff….

Delivering real change is about changing the business

model, through the power of the internet, to create new

provider models….engaging consumers in new, highly

efficient and scalable ways of actually receiving a service.

IT/Informatics operates at the margins of

healthcare….Digital is the future of healthcare delivery!

Our Digital Operating Model

Our Digital Capability Model

Making it Happen –

www.vitalitypartnership.nhs.uk

Further reading