With the release of the new GP contract at the beginning of the year there was immediate discussion about what it might really mean for GPs and the health and care systems they serve.
Now the dust has settled, everyone has had a chance to read the contract changes associated with the NHS Long Term Plan. They’ve come to a conclusion on what this actually means for GPs, networks, federations, GP provider organisations and commissioners. So what’s the conclusion?
While there are elements of funding support that are present in the reforms, there is a definite undercurrent to push general practice back to the epicentre of care and strengthen it to deliver real change. How successfully can it do this?
Bringing general practice into focus
The new GP contract focuses heavily on the need to integrate, taking the primary care we know and love and giving it strength and muscle in the form of Primary Care Networks.
For several years there have been ruminations around creating pockets of general practice that have been based on geography alone, often resulting in fractured mild achievement. Now there is the opportunity to make, shape and deliver or buy for networks. This freedom to ebb and evolve is how success can be achieved.
With the commencement of the Primary Care Network Directed Enhanced Service (DES), the scope of the networks and general practices has started in earnest. Investment in network staff has begun. Year one funding for social prescribers and clinical pharmacists has started, this is providing general practice immediate access to skillsets not previously commonly found in .
PCNs are beginning to find their feet, networks are starting to develop business plans, setting goals and outcomes for the coming short to medium terms. Clinical Directors are now also beginning to think about how to best use their (and their PCNs) time to best achieve their aims and how to interact and interface with each other.
Access for all in a digital future
The movement of digitalisation of general practice continues to be central to what good looks like. For example, taking appointments and making 25% minimum bookable online by July 2019 and then advancing further so that online consultations can be offered by the end of 2019/20. Increasing such portals for usage will see a potential reduction in the ‘Did Not Attend’ rates.
A return to rewarding true quality
Over the last decade the ‘Quality Outcomes Framework’ has become a more menial admin-heavy task that has become a matter of ‘business as usual’ for almost all practices. The new domains for Prescribing Safety and End of Life care focus on two areas that have seen care quality levels questioned in recent years. Future domain inclusions of COPD, asthma, heart failure and mental health in the coming two years afford practices the ability to actively target patients in this run-up period.
The ability for practices to now except patients from indicators with a personalised care adjustment improves results for us all. Adding one of the five reasons of exception will provide an immediate insight into domains and indicators with elevated levels of exception reporting. This will provide intelligence on a practice, network, CCG, regional and national level about condition specific indicators and the common trends that people are being excepted for and thereby clinicians will be able to offer future targeted changes to certain patients cohorts to reduce these exception rates. This should see overall improvements in quality care (and therefore data) for all.
Primary Care Networks are the keystone in ICPs
There are many opportunities afforded to general practice in the new contract changes and DES implementations. GP and Primary Care Networks will be responsible for successful delivery of the new contract and need to start to think and work differently accordingly.
Primary Care Networks are the keystone in Integrated Care Partnerships (ICPs). Being placed in the communities they serve, networks are fundamentally placed to lead on, coordinate and potentially deliver a vast range of out of hospital services as well as having the potential scope to encompass wider based community services as well as aspects of social care.
The importance of delivery success has never been higher and the need to be able to scale up to meet Integrated Care System level challenges poses vast opportunity.
How Attain support your challenges
Reflection on the challenge is expected; it is a mammoth task that has been mandated by NHS England. Attain is helping a number of areas with their network challenges and some of themes of questions we have been asked by general practice include:
- Thinking about care areas, how do we deliver tangible value for money?
- Does the system and network understand its population through robust population health management mapping?
- Are we fully versant in what our opportunities and obligations are for purchasing and procurement?
- Are we cognisant of the impacts our networks will have on existing organisations (i.e. federations and GP provider companies) and how do we work through those matters?
- How do we handle the governance challenges around being potential providers of new or expanded services within our networks as well as commissioners in our GP roles?
- Do we have the skills (pastoral and management) to actively deliver the network ambitions?
- How do we ensure that none of this is to the detriment of the patients and our availability to them?