challenge fund update, windsor 141125
TRANSCRIPT
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www.england.nhs.uk
PM Challenge
Fund
update
Dr Robert Varnam
Head of general practice development
Windsor 25.11.14
Video at
vimeo.com/113578615
Password “cumberland”
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www.england.nhs.uk
Does general practice have a future?
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www.england.nhs.uk
?
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www.england.nhs.uk
Why improve access?
• Patient safety
• Efficacy
• Confidence
• Expectations
• Pressure (victims of our success?)
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www.england.nhs.uk
What do we mean?
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www.england.nhs.uk
We don’t mean…
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bit.ly/GPpolicy2014
Health & wellbeing-promoting care
Responsive access Consistently high quality
Holistic, personalised, proactive, coordinated care
‘Wider primary care, at scale’
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www.england.nhs.uk
Patient
System
Team
Professional
What kind of care
do we want people to get?
What approach
would deliver that?
Who should be
involved? How should
they work?
What work should be
done? By whom?
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www.england.nhs.uk
Responsive access to care
Patients, their families and carers confident that they will get the right
support at the right time, 24/7. It is straightforward to obtain the right
care at the right time from the most appropriate healthcare
professional, through simple and well publicised routes of entry to
care. There is a flexible response to individual needs, through a
greater diversity of consultation types and lengths, including greater
use of telephone, online and video consultations.
Providers make use of a broader skill mix to match staff expertise to
the individual’s need and ability to improve capacity. The barriers
between community-based and hospital-based providers of urgent
and elective care are removed and pathways are improved, to reduce
delays, duplication and gaps in care.
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www.england.nhs.uk
Patient
System
Team
Professional
What kind of care
do we want people to get?
What approach
would deliver that?
Who should be
involved? How should
they work?
What work should be
done? By whom?
Timely, flexible, ‘right care’
Wider primary at scale. One
patient, one record. Joined-
up commissioning, clear
accountabilities.
Seamless collaboration
across journey. Multi-
professional.
Working to ‘top of skills’.
Supported by system. Able
to pull in other expertise.
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www.england.nhs.uk
What are people doing?
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www.england.nhs.uk
100-250k
<100k
>500k
(UK-Wide)
Patients
covered:
Wave one - 254 expressions of interest which
would have served some 35 million patients
but cost £480m
In April 2014, 20 pilots were announced
involving over 1,100 practices and covering
7.5m patients
Po
pu
latio
n c
ove
red
Prime Minister’s Challenge Fund
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1. Understand different needs
2. Reshape demand
3. See the whole system
4. Variety of supply
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www.england.nhs.uk
How to get there?
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Health & wellbeing-promoting care
Responsive access Consistently high quality
Holistic, personalised, proactive, coordinated care
‘Wider primary care, at scale’
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www.england.nhs.uk
bit.ly/nhs5yfv
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www.england.nhs.uk
Multispeciality Community Providers (MCPs)
Primary and Acute Care Systems (PACS)
Two specimens
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www.england.nhs.uk
Multispeciality Community Providers (MCPs)
Two specimens
GP practices
Community nurses
Therapists
Diagnostics
Pharmacy
Dentistry
Specialists
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www.england.nhs.uk
At-scale primary care?
bit.ly/GP4Ps
PurposePartnerships
Proactivity
Possibility
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www.england.nhs.uk
Tips for success
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www.england.nhs.uk changemodel.nhs.uk
vimeo.com/album/3133652
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www.england.nhs.uk
Is there a clear purpose for change which is
understood by all participants, and to which all are
committed?
• Is it clear why you’re doing this?
• Does that connect with others’ motivation?
Bring everyone together to agree what you want to
achieve through this programme.
Always include the purpose in communications.
Our shared purpose
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www.england.nhs.uk
Who needs to be part of this change? How are they
enabled to be collaborators and to take action
themselves?
• Do practices & patients feel like collaborators?
• How to maintain engagement?
Develop initial plans in close collaboration with everyone
who needs to be part of the change.
Engagement to mobilise
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www.england.nhs.uk
Does everyone you need to lead think of themselves as
a leader? Do they have the right skills and support?
• Leadership ≠ management
• Don’t be a hero
• Time, time, time!
Start including others in your leadership team now.
Budget for leadership time & support.
Leadership for change
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www.england.nhs.uk
How will innovations be adapted for local use? How
will you rapidly refine innovations before rolling out?
• You’re not that unique – learn from others
• Very few little is plug’n’play
• ‘Iron out’ before ‘roll-out’
Consider where to have a phased approach for piloting.
Spread of innovation
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www.england.nhs.uk
What improvement methodology(s) will be used to help
redesign and improve systems and processes of care?
How will practices be supported to work smarter, not
just harder?
• Release capacity before anything new
• Ask practices to work smarter not harder
• Build improvement science skills
Ask NHS Improving Quality how improvement tools
could help
Improvement methodology
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www.england.nhs.uk
What approach will be used for programme planning and delivery? How much management staff time will be needed?
• This is a major large scale change programme.
• Ensure sufficient time.
• Secure the right skills.
• Use proper systems.
Budget for additional management capacity, rather than expecting practice staff to find extra time.
Rigorous delivery
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www.england.nhs.uk
Are measures being used which will stimulate
curiosity, drive improvement and demonstrate
progress? Are continuous statistical methods used, to
provide realtime feedback?
• Choose a small number of metrics.
• Select metrics in consultation.
• Plan to produce feedback early.
Have a plan and budget for data collection
Transparent measurement
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www.england.nhs.uk
Patient contact, as a direct result of the change in access
1. The change in hours offered for patient contact;
2. The change in modes of contacts;
3. The utilisation of additional hours offered; and
4. Impact on the ‘out of hours’ service.
Patient experience/satisfaction, including patient choice
5. Satisfaction with access arrangements; and
6. Satisfaction with modes of contact available.
Staff experience/satisfaction
7. Satisfaction with new arrangements
Wider system change.
8. Impact on the wider system attendances
9. Impact on emergency admissions
National metrics
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www.england.nhs.uk
How does this innovation align with the priorities of
local strategy? Does the environment within which
practices and staff operate make it easy to develop and
implement innovations?
• IT, premises, workforce
• Where to connect/piggy-back?
• What would make this sustainable?
Plan together with commissioners from the outset
System drivers
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www.england.nhs.uk changemodel.nhs.uk
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Health & wellbeing-promoting care
Responsive access Consistently high quality
Holistic, personalised, proactive, coordinated care
Our Federationvimeo.com/album/3133652