A Model for Innovative

General Practice ‘Super Partnerships’

Dr Naresh Rati Helen Parker

Concept and Formation

Key Features

• Medically-led Integrated Care Organisation • Large, single entity, GP provider • Integration of GMS/PMS with community and specialist

services • Registered list of 80k plus • Geographically coherent • Multi - site delivery • 5 year Strategic Business Plan • Population Health Planning • Hub for research, training and education

Formation • Motivated local GPs with a vision • Procuring additional capacity and skill set • New partnership agreement and partner status options • Mergers and consolidation • Organisational development +++ - Defined GP leadership and management roles - New governance structures - Centralisation agenda • Clinical and financial decision making absolutely aligned • Brand creation • Evolution, not revolution - but with some pace

Drivers

• Commissioning weak, innovation slow

• GPs history of primary care provider innovation

• Fragmented inner city general practices with quality variation

• Barriers to shifting care into community settings

• Larger scale investments in infrastructure and staff needed

• Patient demand outgrown small practice model

• Financial security

Levers • Motivated and committed GPs

• GP + business development skill dynamic

• In house specialist skills and positive

relationships with local consultants

• Local GP demographics

• Local strategic plan to downsize acute trust

• Strong commissioning influence

Delivering the Business Plan

Vitality: Vital Statistics

List size: 2009 26k 2010 32k 2011 38k 2012 51k

(LCG 125k, CCG, 550k)

• 7 mergers • 14 equity partners (11 wte) + 1 fixed share partner + 2 associate partners • PMS/GMS contracts • 150+ staff • 9 NHS specialist services • 2 private services • 7 primary care sites (plus

university site) • Integrated IT: EMIS Web

across all sites

Service Portfolio Current • Rheumatology • Dermatology • Gynaecology • Orthopaedics • Immunology • X-ray • Substance Misuse • Intermediate Care • Extended Minor Surgery

Pilots • Urology • ENT • Community

Physiotherapy • A&E diversion

Planning • Health and Well Being • Paediatric Assessment • Community Nursing • Pharmacy • Dentistry

2005/6

National SHA Provider Selected PCT Practice Group

Axis Split

2010/11

National SHA Provider Selected PCT Practice Group

Axis Split

Impact on Demand Management: Dermatology

Getting the Foundations Right

• The Super Partnership structure

• New Partnership Agreement

• Corporate governance structure within to operate

• Communication ++

• Lead management roles for partners

• Procuring additional skill set

• Pace of patient and service growth

• Centralisation agenda for efficiencies

Challenges • Impact of CCG development and contracting void

• Degree of influence in CCG and conflicts of interest

• Acute Trust threat

• Local GP politics

• Patient choice

• GP contract changes – maintaining momentum

• IT and informatics to support business planning

Impact • Improvement in quality of primary care and demand

management

• Increased patient satisfaction with practice based services

• Significant local influence

• Less dependence on core contract and increased turnover

• Creating infrastructure for viable alternative to hospital care

• Increased efficiency due to centralisation

• Transforming general practice as a career option– clinical and non-clinical staff

Sustainability

• On a journey from single practice to ICO to…. ACO

• Expand research and education activity

• New models of patient engagement

• Contracting model and shared risk important - Prime contractor, AQP, Programme budgets

• Potential to re-engineer health system accountability and commissioning model

• Future policy framework critical to success

• Impact of new GP contract – potential facilitator

Moving forward….