David Colin-Thomé

1. David Colin-Thomé • National Director for Primary Care, Commissioning and System Management Directorate and clinical lead for 18w programme • Former GP, Castlefields, Runcorn 1971-2007 • Honorary Visiting Professor,Centre for Public Policy and Management, Manchester University • Honorary Visiting Professor, School of Health, University of Durham

2. Benefits of a first contact in primary care.(Starfield) • Higher patient satisfaction with health services • Lower overall HS expenditure • Better population health indicators • Fewer drugs prescribed per head of population • The higher the number of family physicians the lower the hospitalisation rate.

3. General Practice(Roland and Wilson) We identify three areas in which British general practice performs well, leading both international policy analysts and the public to their favourable conclusions: Equity Quality Efficiency and three important characteristics that contribute to this success: Co-ordination Continuity Comprehensiveness

4. General Practice and Health Inequalities (Roland) • Practices in affluent and deprived areas achieving the target of over 80% of eligible women having received a cervical smear. The figure shows not only that overall rates are high and have increased since 1990, but that there has been progressive narrowing of the difference between affluent and deprived districts since 1990 . Similar narrowing in the social gradient for childhood immunisation is seen in this period . • Although there are limitations to the data, QOF scores for practices serving the most disadvantaged populations are catching up with those of practices serving the least disadvantaged populations.

5. Our health, our care, our say – a new direction for community services • Ambition • Enabling health, independence and well being • Better access to GP • Better access to community services • Support for people with longer term needs • Care close to home • Ensuring reforms put people in control • Making sure change happens

6. Six Functions of Primary Care • First point of contact care • Continuous person and family focussed care • Care for all common health needs • Management of chronic disease • Referral and coordination of specialist care • Care of the health of the population as well as the individual

7. PrimaryCare Reform • GP contracts • PC procurement • Quality and Outcomes Framework • Community Pharmacists contract and White Paper • Nursing reviews and leadership • AHP leadership • Practitioners with Special (clinical) Interests • Practice Based Commissioning • Capital into primary care

8. General Practice • Good and universal • Mal-distributed • Inaccessible to significant groups of people • Unwarranted and sometimes large variation in quality • Do we lack ambition -for responsiveness, CQI and scope? • Do we need competition or at least contestability?

9. Personal health services have a relatively greater impact on severity (including death) than on incidence. As inequities in severity of health problems (including disability, death, and co-morbidity) are even greater than are inequities in incidence of health problems, appropriate health services have a major role to play in reducing inequities in health. Starfield 12/03 03-385

10. The NHS and Social Care Long Term Conditions Model Delivery System Better outcomes Infrastructure Case Management Community Resources Empowered and informed patients Decision support tools and clinical information system (NPfIT) Disease Management Creating Supporting Prepared and proactive health and social care teams Supported Self care Health and social system environment Promoting Better Health

11. GP contract Quality of care in a nationally representative sample of 42 GP practices for asthma, heart disease and diabetes 48 indicators.Max score for each condition = 100          First three data points from: Campbell S et al NEJM 2007; 357: 181-190

12. Keeping it Personal • Build on the best of traditional General Practice • Primary Health Care more than general practice • …but registered population and 80% of all NHS clinical consultations • 90% of care solely undertaken in primary care • Support for self care • Long term conditions management • Care Closer to home • The practice can link the wider public’s health and bio-clinical care • The practice as the local micro yet strategic health organisation

13. Our NHS, Our Future • Fair –Mal-distribution, Often lower performance for patients from socially deprived communities- • Personalised – White paper ambition, a want is a need, segmentation, PROMs • Effective –VFM, skill mix, variation in performance even when similar demography, reflective practice, use of evidence base, inappropriate/ineffective interventions • Safe –Accreditation and regulation, NPSA advice • Locally accountable – ‘transparent accountability leads to transparent autonomy’, PPG, different forms of ownership And focused relentlessly on improving the quality of care=‘What patients value’

14. Darzi (1) • new GP practices for deprived areas • New resources for over 100 new GP practices with 900 GPs/nurses/assistants into the 25% of PCTs with the poorest provision. Will be based on those with fewest primary care clinicians, lowest patient satisfaction with access and poorest health outcomes. These new practices will increase capacity and offer an innovative range of services, including extended opening hours. • GP-led health centres for all PC • New investment to establish new GP-led health centres in every PCT area, offering flexible range of bookable appointments, walk-in services and other services for either non-registered or registered patients. Guiding principle to ensure that public can access GP services at any time between 8am and 8pm, seven days a week • extending opening hours for at least 50% of GP practices • each weekend or on one or more evenings each week. Where existing GPs do not start to offer these extended services, PCTs will be able to commission new services from other GPs, GP federations or other providers. • linking greater proportion of pay to patient satisfaction • We will ensure that an increasing proportion of the NHS payments made to GP practices are linked to their success in attracting patients, and the views of their patients, including advance appointments and the ability to see a GP in 48hrs-Later this month key information about all GP practices including the results of the patient survey, practice opening times and performance against key quality indicators – will be made available on a single website, NHS Choices via www.nhs.uk.

15. Facts and Myths • No national plan for ‘polyclinics’ –is a local decision • No GP ‘factories’ • But we do want extra services where there are GP practices

16. Next Stage review-Darzi (2) • Deliver vision across eight areas of care • -Maternity and newborn • -Children’s health • -Planned care • -Mental health • -Staying healthy • -Long term conditions • -Acute care • -End of life care

17. NHS NEXT STAGE REVIEW: PRIMARY AND COMMUNITY CARE STRATEGY • Shaping services around individuals; • Promoting healthy lives; • Continuously improving quality; • Leading local change.

18. PBC • Practice and PCT-meeting of two expert organisations • Make or buy (treat or refer) within or without extended primary care team • Commissioning for the individual patient=being a good GP/other PC clinician • Budget holder-responsibility and transparent accountability for economy, efficiency and effectiveness • So provider/commissioner/budget holder =MCO English style • Commissioning support for PCT • Extended provider (beyond the role of the GPs/other clinicians for their own registered patients) requires good clinical and corporate governance within a contractual framework

19. Commissioning Primary CareQuality (What Patients Value) • Availability and Accessibility • Technical Competence • Communication Skills • Interpersonal Attributes of Care • Continuity of care • Range of On-Site Services

20. Public’s Health • Centrality of local government • Population responsibility of PCT,PCT and general practice • Role of third sector • Public health component of individual consultation • Locus of control-eg social enterprise, self care, individual budgets, Sure Start, Family Nurse Partnership