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Future of General Practice and Workforce Development. Dr. Nadim Fazlani Chair Liverpool Clinical Commissioning Group. Birth of the NHS. Birth of NHS. 5 July 1948, following an official unveiling at Park Hospital (now Trafford General Hospital) by Health Secretary Aneurin Bevan
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Future of General Practice andWorkforce Development Dr. Nadim Fazlani Chair Liverpool Clinical Commissioning Group
Birth of NHS • 5 July 1948, following an official unveiling at Park Hospital (now Trafford General Hospital) by Health Secretary Aneurin Bevan • NHS will last as long as there are “folk left with the faith to fight for it". • 1,143 voluntary hospitals with some 90,000 beds and 1,545 municipal hospitals with 390,000 beds are subsumed within the new NHS.
Core Principles of the NHS • The health service would be available to all and financed entirely from taxation • That it meets the needs of everyone • That it be free at the point of delivery • That it be based on clinical need, not ability to pay
Crisis in general practice • 2007 average patient 3.19 consultation • 2013 average patient 6.34 consultation • Last ten years, the number of hospital consultants is up by 76% in whole-time equivalent terms • No SAS equivalent in general practice • Not clear numbers of full time equivalent in General Practice
Crisis in general practice • the number of GPs per 100,000 head of population across England 54 in 1995 and in 2009 was 59.5 • 65% trainees in General practice females • 40% of women who leave practice each year are under the age of 40 • HEE target is 3250 GP trainees per year • Trainee numbers stuck around 2700
Crisis in general practice • Lack of training capacity • 2013, 4100 (60%) doctors entered hospital specialty training compared with 2800 (40%) doctors into GP training • 2% reduction in medical students intake • The overall applicant pool is not big enough to support GP expansion without proportionate reduction in specialty training numbers.
Have we been here before? • 1957 John Pringle, the BMA's press officer, announces that GPs are being advised to resign from the NHS and return to private practice. 5 shilling for consultation • 1966 Cartwright found GPs complaining of neglect and impoverishment. Morale is poor and recruitment is proving difficult.
BMJ Obituary • General Practice died on 31st March 1990 after a turbulent illness in large part precipitated by the importation of industrial management into general practice.
Principles of designing future • Working in multidisciplinary micro-teams • Integrating generalists and specialists • Federated organisations (organised networks of teams) • Modernising the patient-clinician consultation • Flexible and remote types of consultation
New Care Models • Multispecialty Community Providers • Primary and Acute Care Systems • Viable smaller hospitals • Urgent and emergency care networks • Consolidated specialised services • Modern maternity services • Enhanced health in care homes
Structural Models (UK) • Community health organisations (Bromley by Bow Centre) • Regional and national multi-practice organisation(Hurley Group,The Practice PlC ) • Marginalisedgroups (Leicester Homeless Primary Health Care Service,) • Networks or federations (Tower hamlets) • Professional chamber (Pallant Medical Chambers)
Structural Models (UK) • Super-partnerships(Whitstable Medical Practice) • Super-partnerships with inpatient facilities (Nairn Healthcare Group)
International models • Accountable care organisations • Community-owned(Hokianga Health Enterprise Trust, New Zealand) • Specialist primary care(ParkinsonNet, the Netherlands) • Vertically integrated systems( Kaiser Permanente, USA0
Making it happen • Workforce Development • Scaling up and keeping it local • Infrastructure • Leadership
Role for CCGs • Can already commission additional services from general practice (over and above core general and primary medical services) • Co-commissioning Primary care , greater role of CCGs’ involvement in developing, commissioning and assuring the quality of primary care. • To work closely with patients and public to design and develop high quality primary care
Workforce Transformation Developing a workforce responsive to changes in care, now and in the future Ensuring sufficient supply of highly skilled staff Up-skilling staff Developing and promoting new ways of working
Primary Care Workforce Transformation Programme to September 2015 August 2014 • Now • Data collection, analysis and modelling • GP expansion programme • Assistant Practitioners • Advanced Practitioners • Community Specialist Practitioner • Expanding student placements in primary care • An anticipated allocation for CPD • An anticipated allocation for 12 GP returners across North West • Near Future • Conversion programme (secondary to primary) • Foundation programme (Practice Nurses) • Care Certificate for HCAs • Expansion of apprenticeship programme into general practice and community-based care • £150k for return to nursing • Opportunities • Build multi-professional training capacity, exploring e.g. the federated education practice model • Scope and develop new roles if required e.g. physician associate, health co-ordinators • Career framework – clinical and non-clinical staff • Exploring peripatetic model for practice supervision