Primary Care FIT FOR 20:20

1. Primary Care FIT FOR 20:20 GP Contract Seminar DUNCAN MILLER Programme Manager – More Scottish GP Contract

2. NHSScotland • 5.3 million people • £12 billion • 14 Health Boards • 8 Support Boards • Integrated delivery • Moving towards social care integration

3. “2020 Vision” • Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting. • Integrated health and social care; • A focus on prevention, anticipation and supported self management; • Where hospital necessary, day treatment the norm and focus on getting people back into their home as soon as appropriate, with minimal risk of re-admission.

4. The Healthcare Quality Strategy for Scotland • Person-Centred- Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making. • Effective- The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. • Safe - There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.

6. The Importance of Primary Care The foundation of the NHS: Over 90% of interactions with healthcare start and finish in primary care. Key to addressing: • Inequalities in health and care; • Access to health (and often social) care.

7. The Challenges • Demographic shift to an ageing population • Ageing brings a more multi-morbid population (two or more long term conditions) • Worsening health inequalities This matters because: • Living with multiple conditions is the norm rather than the exception for many people. It is associated with poorer quality of life, more hospital admissions and higher mortality, and significantly worsens the impact of deprivation. But: • We still tend to design healthcare along single disease pathways

8. Multimorbidity is common in Scotland • The majority of over-65s have 2 or more conditions, and the majority of over-75s have 3 or more conditions • More people have 2 or more conditions than only have 1

9. There are more people in Scotland with multimorbidity below 65 years than above Particularly true in more deprived areas There are very few generalist hospital services for the under-65s

10. People living in more deprived areas in Scotland develop multimorbidity 10 years before those living in the most affluent areas

11. Primary Care FIT FOR 20:20 PC Strategic Assessments and development plans • Assessment of current local provision – strengths, weakness, interventions; • Vision of what needs to be achieved for 20:20; • Development Plan - priority areas; • Workforce – skill mix and new models of care.

12. Primary Care FIT FOR 20:20 New integrated models of care • Improve person-centred care; • Improved team working around the needs of the individual; • Meets the needs of the locality; • Better addresses multiple morbidity; • Optimises working relationships across all sectors.

13. Primary Care FIT FOR 20:20 Contractual arrangements • Development of the more Scottish contract – impact of the independence referendum; • Opportunity for joint working with Community Pharmacy – Wilson Report/ Prescription for Excellence; • Wider impact of Health and Social Care Integration – GP clusters; • Dental and Optometry.

14. Primary Care FIT FOR 20:20 Better Primary Care data • National GP Information Services; • Primary Care data set – variation and benchmarking; • Unscheduled care datamart • OOHs performance indicators.

15. Primary Care FIT FOR 20:20 GMS Contract Agreement in Scotland 2014/15 • 264 points retired, with funding transferred to GS • 151 points from clinical QOF, 80 points from disease registers and 33 points from patient experience • For clinical changes – expectation is that GP practices continue to provide care that is clinically appropriate • Return to 15 month review cycle

16. Primary Care FIT FOR 20:20 GMS Contract Agreement in Scotland 2014/15 • New patients still be to coded at diagnosis and provide clinically appropriate lifestyle advice • New Quality and Safety Domain • Nominated liaison GP for H&S integration • Review of Access • Continuous Quality Improvement • ACPs continue – annual report/ SEA cease • Patient Safety

17. Primary Care FIT FOR 20:20 GMS Contract Agreement in Scotland 2014/15 • Publishing GP Earnings – greater transparency • Support the development of a Scottish GP Contract over the next 3 years • Important role of GPs in the development of Health and Social Care Integration • Impact of caring for elderly population, and patients in deprived and rural areas • Recruitment and retention – Golden Hellos, Seniority

18. Primary Care FIT FOR 20:20 Scottish GMS Contract Arrangements 2014 -2017 • No planned major change to QOF – will be kept under review by SG/ SGPC • NICE recommendations out – Diabetes Bundling, Hypertension and AF changes – still under consideration • Work with SGPC to develop a Scottish GMS Contract from 2017 onwards to support 2020 vision for Health and Social care

19. Primary Care FIT FOR 20:20 Scottish GMS Contract Arrangements 2014 -2017 • Golden Hellos • Remove automatic entitlement: focus on remote, rural and deprived areas • greater flexibility on payment • Support for appraisal for sessional locum GPs • Support for GP Returners • Publication of GP NHS Net Earnings – develop ‘model’ report on GP Practice data held at Practitioner Services Division

20. Primary Care FIT FOR 20:20 Scottish GMS Contract Arrangements 2014 -2017 • Seniority Payments • £18m currently spent across Scotland • Review of current programme to consider how best to deploy this resource to support the sustainability of general practice in Scotland • Others important areas • Review of the Scottish Allocation Formula – financial framework to support the Scottish GMS Contract going forward • Review of variability of funding to ensure funding supports general practice across Scotland but addresses inequity • Review of immunisations

21. Primary Care FIT FOR 20:20 Scottish GMS Contract Arrangements 2014 -2017 • Others important areas (continued) • Work with emerging Health and Social Integration Authorities to ensure general practice plays leadership/ integral role in the development of locality planning arrangements • Work with the programme supporting the implementation of Prescription for Excellence • Others contractual areas • GP workload • Infrastructure (GP Premises and IT) • Enhanced Services • Recruitment and Retention

22. Primary Care FIT FOR 20:20 Questions/discussion