NHS GRAMPIAN BOARD

AberdeenCity Community Health Partnership

Primary Care Redesign – AberdeenCity

Aim

The purpose of this paper is to:

  • Provide a status report to the NHS Grampian Board of the Primary Care Redesign – Aberdeen City Programme
  • Highlight to the Board the plans for further clinical leadership and engagement
  • Highlight to the Board the new model of collaborative working.

Strategic Context

NHS Grampian has clear strategic priorities in relation to Shifting the Balance of Care, improving health inequalities, reducing the demand for unscheduled care, increasing capacity to meet the demographic challenges and improving efficiency (reducing costs).

Discussion

Background

  1. In Aberdeen, General Medical Services (GMS) was demonstrating signs of decreasing stability. There was little engagement from GPs in the operating of NHS Grampian or Aberdeen City Community Health Partnership (CHP). The focus was on maintaining GMS services against a backdrop of rising costs and increasing patient demand.
  2. The majority of General Practices in the City remain independent contractors. Independent contractor status has throughout the history of the NHS allowed rapid change. Engagement of GPs in driving forward NHSG strategy will give the rapid changes that are essential in the current economic climate and to meet the timetable attached to NHS G capital investment plans (e.g. Emergency Care Centre).
  3. In 2008 NHSG Operational Management Team (OMT) approved the launch of a three year programme of Redesign in AberdeenCity to ensure that Primary Care services would be designed to cope efficiently with future demands.
  4. These demands include; enabling the Shift of Balance of Care (SBC) to take place efficiently, our rapidly increasing elderly population, our premises limitations in the City, our GP/nursing workforce demography. These practical demands are additionally set in the context of serious, medium-term fiscal constraint.
  5. To support existing redesign activity, e.g. practice mergers, practice boundary changes, from July 2009 a structured programme to design, manage and deliver the changes necessary for the future has been running; engaging deeply with the GP and broader primary care community in the City. This includes public and patient communication and involvement.

Stakeholder Involvement

  1. The programme has succeeded in building GP engagement and ownership. A Design Team was created with strong GP representation (8 GPs) and a GP Lead from each practice has been assigned (31 GPs).
  2. GPs increasingly understanding the need for rapid change in the model of NHS services.
  3. New structure of cluster clinical leadership is being implemented froma desire to work in a federated model. This allows for shared resources, less duplication and more sustainable workforce design. Aim to create ‘virtual ward’ where GPs, community nurses, Allied Health Professionals (AHPs), Consultants (from geriatric medicine, mental health and old age psychiatry), out-of-hours services and social work join together keeping patients out of hospital.
  4. 20 GPs committed to work on various aspects of the Redesign. Particular projects are proceeding e.g. joint work with geriatrician on community geriatric model of care to reduce demand for inpatient services.
  5. A new model of collaborative working is emerging both within Health and also cross-agency with general practice taking a central role in developing these relationships to be focused on specific patient communities.

Assessment

  1. One practice merger completed this year; next scheduled for December 2010(model not dependent on mergers).
  2. Boundaries work ongoing – with patients gradually being relocated from one practice to another across the City to improve alignment between practices and communities. Dovetails with Community Nursing redesign.
  3. A data extraction project has commenced, aiming to understand better the work carried out in GP practices and how this can be stopped, reallocated to other professionals, redesigned to increase GP capacity to take on work from acute sector.
  4. Parallel work is underway with Geriatric Medicine within the Intermediate Care Programme to ensure both programmes come together.
  5. There is joint working with Long Term Conditions Collaborative, Unscheduled Care Network and Better Care Without Delay (BCWD) to dovetail capacity creation with need from other programme boards.
  6. Use of Section 17c contract is being investigated to release time from bureaucracy and focus GP Practices on delivery NHS G strategic outcomes. (both being shared with other CHPs).

Next Steps

  1. Appoint cluster clinical leads, to start from 1 January 2011
  2. Continue to align CHP resources to cluster model.
  3. Section 17c flexibilities continue to be explored, discussed with other CHPs and Scottish Government Health Department (SGHD) Primary Care to identify if this will release significant capacity or not.
  4. Work with geriatric medicine continues to be a high priority.
  5. Work with dermatology (or other acute speciality) becomes a project .
  6. Practice boundary work continues in the quiet, non-headline attracting manner .
  7. Continue discussions with Aberdeenshire about Commuter Belt.

Key Risks

  1. Lack of engagement in any programme of change is a central and very real risk. Our approach to engagement has been to work closely with a central core of ‘early adopters’ who can influence wider behaviours and attitudes. This has been supported both by our GP Redesign Leads from each practice in the City and by NHSG/CHP senior team. The GP cluster leads will further mitigate this risk.
  1. A further risk is the lack of connectedness this redesign may suffer in the face of competing demands and pressures from other redesign (local and national). It is therefore vital that we continue to use a common language that links our key strategic components (Healthfit, Health & Care Framework) to this redesign and the changes that will flow from it.

Conclusions

  • Significant foundation work has been completed to help create the right mechanisms and environment for change to occur in Primary Care
  • The Primary Care Redesign program is entering an exciting period as the opportunities for more focussed, population-based care become possible. General Practice, through the GP clinical cluster leads, will take on a highly influential role both within the 4 clusters in the City and also across their multi-disciplinary/multi-agency colleagues
  • The Programme must continue to build on the good levels of engagement from general practice and ultimately align, much more closely, the CHP/NHS Grampian leadership teams with ‘corporate’ General Practice.

Recommendations

NHS Grampian Board is asked to:

  1. Note the progress made to date.
  2. Endorse the approach to clinical leadership and engagement, in particular to recognise the importance of the clinical cluster lead roles.
  3. Support the programme and the cluster leads as we embark on an exciting model of collaborative working.

Executive Lead

Dr. Roelf Dijkhuizen, Medical Director, NHS Grampian

Mr Gary Newbigging

Programme Manager

AberdeenCity Primary Care Redesign

Mrs Heather Kelman

General Manager Aberdeen City CHP

Programme Co-sponsor

November 2010

1