Collaboration in general practice

Collaboration in general practice: Surveys of GP practices and clinical commissioning groups | Nuffield Trust |  Royal College of General Practitioners

This report summarises the results of two surveys, sent to general practice staff and to CCG staff, aimed at finding out what had changed in the landscape of general practice since the previous surveys two years ago and to explore what GPs feel the future holds for them.

Key findings include:

  • The scaling up of general practice continues apace with 81% of general practice-based respondents reporting that they were part of a formal or informal collaboration, up from 73% in 2015.
  • However, the landscape is complex. Practices often belong to multiple collaborations that operate at different levels in the system, having been set up to fulfil different purposes.
  • The main priorities of all collaborations over the last year were: increasing access for patients, improving sustainability, and shifting services into the community. The priorities differed by size of collaboration. Both providers and commissioners reported that time and work pressures were the biggest challenge to collaborations achieving their aims.
  • When asked about developments in their local area, over half of GP staff and one-third of CCG staff surveyed felt practices and collaborations had not been at all influential in shaping the local sustainability and transformation partnership (STP). Only one-fifth of GPs thought STPs would deliver meaningful change in primary care. CCGs were more optimistic, with 61% reporting that meaningful change was probable.
  • When questioned about future models of care, around half of practice partners (53%) said they would be ‘unwilling’ or ‘very unwilling’ to give up their current GMS/PMS/APMS contract1 to join a new models contract (e.g. MCP or PACS contract2). The most common reason they gave was that they did not want to lose control of decision-making and leadership in their practice.

The report can be downloaded here

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Strategic commissioning

Steering towards strategic commissioning: transforming the system | NHS Clinical Commissioners

Clinical commissioners are playing a key role as architects of the changing health and care landscape, analysis shows. A new publication by NHS Clinical Commissioners sets out CCGs’ vision for the future and what they need to get there at pace so they can deliver more for patients.

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Image source: http://www.nhscc.org/

Steering towards strategic commissioning shows there is a strong belief that healthcare commissioning must continue to be clinically led, operate at a scale larger than a CCG footprint, retain its purchasing function and remain accountable to the local population.

The analysis, which was informed by a survey and interviews with CCG leaders, shows that CCGs are embracing change, with 77 per cent of those surveyed intending to contract for a new care model in 2017/18, and 72 per cent planning on increasing their collaborative commissioning.

Related: The Changing Commissioning Landscape

‘Trust and collaboration within vanguards is essential but not easy’ – new report

A new report launched today (15 June) at Confed17, looks to better understand how to build trust across systems to promote more effective collaborative working | NHS Employers

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Trustworthy Collaboration, written for NHS Employers by Prof Veronica Hope-Hailey of the University of Bath, explores the challenges of building trust across health systems, in the context of the 50 vanguard sites tasked with delivering transformational change through new care models.

The report looks into the challenges facing the leaders of the partner organisations within the vanguards, who are required to collaborate to deliver transformational change. Trust is essential to collaboration, the report states, but achieving this is easier said than done.

For the vanguards, trust was an important ingredient for ensuring success. It was vital for senior leaders to swiftly establish trust with other leaders across multiple and complex systems.

The report explores the meaning of trust in organisations and offers six key recommendations for how to successfully achieve it.

Strategic commissioning

NHS Clinical Commissioners, in partnership with Academic Health Science Networks (AHSNs), has published Supporting strategic commissioning: collaborative working between CCGs and AHSNs.

This briefing explores how CCGs can work with AHSNs to support local strategic commissioning and provides a series of tips through case studies which demonstrate the impact that collaboration between CCGs and AHSNs can have for local populations.

Case studies in Supporting strategic commissioning that demonstrate the impact that collaboration between CCGs and AHSNs can have include:

  • the reduction of anti-coagulation treatment costs by £1 million while at the same time improving patient outcomes in Newcastle;
  • a six day fall in referral admission times for patients with acquired brain injuries in London; and
  • the development of a platform able to predict when a patient would present at a hospital if no intervention took place in Somerset.

The future of commissioning

NHS Clinical Commissioners have published a paper setting out their vision for the future of clinical commissioning.

Informed by interviews with CCG leaders and other key players in the health and care sector, The future of Commissioning suggests that we will continue to see an evolution in the commissioning system but that it remains a vital part of the health system that is focused on delivering for patients and local populations.

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Enhanced Health in Care Homes model

One in seven people aged 85 or over is living permanently in a care home. The evidence suggests that many of these people are not having their needs properly assessed and addressed. As a result, they often experience unnecessary, unplanned and avoidable admissions to hospital, and sub-optimal medication.

The enhanced health care homes model  lays out a clear vision for providing joined up primary, community and secondary, social care to residents of care and nursing homes, via a range of services.

Seven key components and eighteen sub-components which define the care homes model are put forward, with practical guidance explaining how organisations and providers can make the transition and implement the whole model.

These plans can help transform the way care is delivered, with staff from across health and social care organisations working together as part of multidisciplinary teams  to deliver high quality and financially sustainable care.

The enhanced health in care homes (EHCH) care model is one of a number of new care models that are delivering whole population healthcare. It will become a core element of the multispecialty community provider (MCP) and primary and acute care system (PACS) models.

Primary and acute care system (PACS)

NHS England launches frameworks to increase integration of health and care services

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NHS England has published Integrated primary and acute care systems (PACS) – Describing the care model and the business model

A PACS can be defined as a population-based accountable care model, with general practice at its core. It is organised around patients’ needs and aims to improve the physical, mental and social health and wellbeing of its local population.

However, it will also include most hospital based care, as well as primary, community, mental health and social care services. By aligning the goals and incentives of hospitals with other health and care providers, it offers the potential for a radical new approach to population health.

The integrated (PACS) Framework outlines the next steps required to set up the model – including the need to develop new contractual, funding and organisational form. It sets out three contractual options that will help make a phased transition towards a fully-fledged PACS – a single provider with a single contract for all local health and care services.

This puts clinicians in the driving seat by pooling and allocating resources to areas that will have the greatest impact on the health of their local community and creates a shared responsibility towards the most vulnerable patients.