Transforming General Practice

Unlocking the Potential

Current Market Context • Increased demand for primary care • GP contract – doing more for less • CQC and new QoF - ‘demonstrating quality’ • CCG developments and pressures on commissioners • Shift of focus of care from secondary to primary • Greater cooperation with social care • GP demographics • Think Tank focus on the organisational model of general

practice e.g. Nuffield Trust and Kings Fund reports July 2013

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 remains largely unchallenged

by commissioners • Current GP model unsustainable: economics,

demographics • Our interest in applying ‘best bits’ of Kaiser, Physician

Groups to English system

Traditional Practice Model Federations ‘Super Partnerships’

(Sole trader, multi-partners)

Full Merger/Integration Collaboration Consultation

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

Emerging Models in General Practice

The Vitality Partnership

• Built on local general practice with local GPs • Single partnership • Delivery at scale: 50k + patients • Clinically and quality focused • Commercial structure

Key Features of the Partnership

• Integrated planning and delivery of general and specialist services in community based modern facilities

• Single IT system – shared records • Population management to support business

planning • Foundation for large education provider • Shortlisted for National Integrated Care Pioneer

Growth and Development

List size: •2009 26k •2010 32k •2011 38k •2013 50k (LCG 125k, CCG, 550k)

• 15 equity partners + 3 fixed share partners • PMS and GMS contracts • £10m+ turnover • 200+ staff • NHS specialist services • Private services • 7 primary care sites (plus

university sites)

Strategic footprint

Vitality Partnership

Innovative Organisational Dynamic

Partners

Salaried Partners

Associate GP

Salaried GP

Corporate Overview

Partnership Structure

• Executive Partner • Medical Director • Managing Director

• PPI lead • HR and workforce • Estates • Commissioning

• Director of Primary Care

• Director of Specialist Services

• Outlet Directors • Comms and

marketing • IT and informatics • Teaching/Training

Organisational advantages

• Deliver Services at scale • Long term planning and investments • Greater ability to bid for AQP • In house business development • Greater level of local influence • Staff employment protection and development • Multi -sites – patient choice • Standardised policies and procedures

Clinical Quality

• Increase in overall quality in merging practices (QOF points increase, access increase, range of services)

• Increased uptake of flu vacs, cytology etc. • Reduction in OPD referrals in merged practices • Integrated care pathways • Single patient record (EMIS web) • Peer review of referrals and prescribing

Evaluation to Date CLINICAL •↑ QOF in merged sites •↓ OPD referrals •↑ vac and imm uptake •Single patient record •Standardised policies, protocols •Active referral management •Integrated pathways •↑ influence in CCG service development

ORGANISATIONAL •Broader GP partner structure •Cultural change •Integrated Central Management Team •Phased retirement plans •Centralisation e.g. supplies, contracts, notes summarisation, data reporting •PPI development

Patient Engagement

• Greater level of strategic discussions • Increased scope of topic feedback • Changes to practice information – pt led. • Prompt feedback on service change • Innovative surveys

Challenges • Clinical time investment into merged practices • Financial investment • Culture change – partners and staff • Communications – vision and decisions • Local GP politics • NHS in transition (PCTs/NCB/CCGs) • Accurate data to enable service planning and

evaluation • Optimum size? How much risk?

Challenges (2)

• Lead and manage merger and acquisitions • Strategic business and investment planning • Organisational development • Property and estates support • Legal, accountancy, financial management and

HR support • New business and market opportunities

Our Vertical Integration

•Rheumatology •Dermatology •Orthopaedics •Immunology •Substance Misuse •X-ray •Intermediate Care

•ENT •Urology •Paediatrics •Neurology •Pain Management •Gynaecology

Our Horizontal Integration

• Community partnerships • Health and wellbeing services • Social Care • Mental health

Further reading