REFINING PRIMARY CARE
& OUR GOAL FOR 2018/19
LivingCare Medical Services are proud to be able to deliver primary care across London. We are a GP led organisation who take pride in its ethos of high quality service that effectively meets clinical need.
Primary Care is the first port of call for many individuals accessing the National Health Service. As an independent provider we want to ensure we are responsible, value for money and ensure we spend public funding wisely.
Our services are not different to that of any other GP partnership and we remain GP owned and managed.
Across the UK the government set out a plan to help primary care meet the demands that are placed on it. These demands are natural under the progression of medicine and treatments and as such individuals are living longer with more complex needs. The government strategy called “General Practice Forward View” focuses on 10 key impact actions. These are:
1. Active Signposting
2. New Consultation Types
3. Reduce “Did Not Attend (DNAs)”
4. Developing Teams
5. Productive Workflows
6. Personal Productivity
7. Partnership Working
8. Social Prescribing
9. Support Self Care
10. Develop Quality Improvement Expertise
The government has laid out these actions to help ensure that primary care is sustainable.
WHAT THIS MEANS FOR LIVINGCARE SERVICES?
LivingCare want to see sustainable health care delivery from all their sites. We want to work with our patients, carers, our
commissioners and our localities to deliver high quality care that can serve generations to come.
TO DO THIS, LIVINGCARE PROPOSES:
We want to be able to offer convenience to our patients. We want to adopt existing technology such as Skype and eConsult to enable patients the ability to have a video consultation from their own home. We will still ensure that patients can access face to face appointments in person with clinicians at their surgery and also the option to have telephone consultations.
We would like to support patients in ensuring that they have holistic care that meets the needs of all our patients. Traditionally a Doctors Surgery would only look at physical symptoms. Whilst this is still predominately what we see we need to adapt to the realities of illness. Illness presents in many ways. A fair cohort of Long Term Conditions could be prevented through changes in an individual’s lifestyle and wellbeing. We want to be able to deliver proactive care to our patients. This would see our receptionists being able to speak to patients about various lifestyle and wellbeing options that we will offer at our practices or available through other services in the local community.
LivingCare want to enable our teams to have time to care for our patients. Often our teams have significant administration to undertake at our practices. We are proposing to centralise some of the administrative (clinical and non-clinical) to enable our staff more time to work with our patients. We will not be transferring any patient records between sites and it will all be done through the clinical systems of the practices. We want to employ a clinical skill mix centrally that can be deployed to work across all sites such as a prescribing pharmacist to enable good medicines management and review of patient’s medications. It maybe that some of our patients will have appointments with a pharmacist to discuss the effectiveness of their drugs and tablets.
LivingCare believe that good teams deliver strong services. We want our staff to be happy and enjoy working for our organisation. This means we have to develop good strong teams that meet the clinical needs of our patients. We use data from our sites to identify what clinical skills we need to meet patient health needs. This then enables us to target or train individuals that will be effective. By ensuring we can meet patients health needs it enables our teams to focus on their roles. We will only ever employ individuals who will fit in and work with our teams. As part of this it means we will only ever employ locum staff on a long-term basis who we have been through full compliance checks and know their ethos and clinical practice.
We recognise we have loyal and dedicated teams. We also know the pressure that the profession creates on all involved. Many of our team join us to make a difference to individuals lives and to help ensure that they can live their life to the best of their ability. Its what makes us proud to be in this industry. We want to ensure our teams have good work life balance, flexibility and ensure retention. We want to be an employer of choice.
Being a responsible provider:
We recognise that we need to work effectively in the locality. We want our patients to access services across the locality. We recognise that this comes through partnership working across the localities. We want to ensure appropriate pathways so our patients can get care closer to their home in a timely manner. Being a responsible provider is about ensuring delivery and trust in ability to deliver. It requires communication and responsiveness. LivingCare will ensure that it does this. This will start with attendance at locality, federations and Clinical Commissioning Groups.
Social Prescribing and Social Value:
As LivingCare is a business that was formed on local delivery and through our founder, Dr Stephen Feldman, wanting to ensure his patients have access to appropriate care at their GP practice. In the same way, we want to ensure that our services are integrated into the community. We want to develop services that are reflective and sensitive to the community they serve.
We want to deliver proactive primary care. To do this we need to redefine what primary care is and go back to the concept of what it was set up to provide.Primary Care was originally the family doctor, who understood and took time to care. They knew their community and the challenges it faced. The doctor would see generations of families and know their lifestyle, their habits and about them as individuals. The element of knowing the whole person is more relevant than ever. We want our services to look at what we call “the whole person paradigm”. Primary Care is no longer just around physical health. It has to be around:
• Mental health
• Social Networks
• Community Integration
• Economic Wellbeing
These 6 factors are key attributes to an individual’s health. Whilst we can treat physical health with drugs and surgery we will only ever be reacting and never preventing.
We will work with our Care Navigators and community organisations to develop a strong structure to enable patients to achieve outcomes in all of the above. The patient will work alongside outcome plans and these will be included as part of the patient’s clinical records.
Supporting Individual Health
We know that at times getting ill can be scary. Its good to be able to speak to a clinician and be reassured on your health or be treated quickly. We will always want our patients to have this access. But we also believe that we need to be able to support our patients to develop resilience and care for some illnesses themselves where possible. We want to enable our patients to self-manage their conditions. We want to develop a programme of activities which all our patients and individuals in the community can access including:
• Choirs to help people with COPD & increase their lung capacity
• Workshops for children with asthma to encourage physical activity
• Weight management and lifestyle advice
• Coffee Mornings and Knit & Natter sessions to reduce social isolation
• DIY First Aid – helping individuals with quick tips and support for home emergencies
• Paediatric First Aid – supporting parents of young children and managing minor illnesses
We also want to support individuals on accessing the NHS and Urgent Care, on providing health advice to support patients in their own resilience. We want to be able to develop a community based asset approach, owned and coproduced by our communities in which we serve.
We will continue to listen to patients and we want our patients to have a voice through our PPGs and through active dialogue along with the standard methods for providing feedback. We continually will look at ways of how we can improve our patient care.
We have developed our clinical models based on demographic needs of each practice and ensuring we can deliver the care we expect to deliver. To do this we have considered data on our practice and developed a model of care that we feel is able to effectively meet clinical need. This model will ensure compliance with contractual requirements and exceeds the typical Carr-Hill weighted formula.
We will never share your personal medical record without your consent. We do share practice level data across organisations who are part of the NHS Data Security and Protection Toolkit Standards. This data will never contain personal data and will never identify any patient or contain their personal information. This will be at a high level to inform community and health needs.
So how do we get there?
We recognise that the above is ambitious. We are an ambitious provider who wants to be able to ensure community health needs are effectively being met. We recognise we cannot do this on our own and this needs the engagement and support of all individuals involved in the services we deliver.
We want to be a provider our patients and commissioners are proud of. We want to know that we meet clinical need and add social value.
We have outlined our proposals within this leaflet and want to hear about any ideas, thoughts or any worries that individuals and organisations may have. We also do not want to duplicate any other agendas or projects that are currently underway within CCGs as this is a waste of resource.
What we propose it will look like:
• Strong Clinical Leadership across all sites
• Salaried Workforce that is committed to the locality and local community
• Centralised back office administration underpinned with robust processes
• Centralised telephone handling ensuring quick response time and effective management of patient queries
• Centralised Telephone Appointments and Digital Consultations enabling resilience and consistent delivery of alternative
• Community Based Programme of activities that are proactive in health improvement
• Development of community based assets to add social value and community resilience to health and wellbeing
• Use of Data to inform commissioning, service delivery and how we effectively meet patient needs.
Where we want to get to:
• Delivering CQC outstanding or elements recognised as outstanding by 2020 across all sites
• Ensure all patients have opportunity to access Care Navigation by September 2018
• Patient Population of 30,000 by November 2019
• 90% of clinical roles to be filled by salaried staff by end of 2018
• Increase some GPs appointments to be 15 minutes by early 2019 for routine care
• 10% of our consultations to be undertaken through digital platforms by early 2019
• Over 1000 patients accessing community based proactive health activities by early 2019.
Our Commitment to Patients
1. We are committed to ensuring we meet the clinical needs of our patients.
2. We will ensure equitable access for all our patient cohorts within our services.
3. We will embrace technology to develop services that are able to futureproof current needs and for future generations.
4. We will ensure all our patients have the ability to raise concerns, ask our team questions and have credible responses
5. We will ensure that we develop community led proactive primary care.
Our Commitment to Commissioners
1. We will ensure that we are a responsible provider of primary care within the community
2. We will admit our faults and ensure that where we do not meet our standards we will provide action plans on remedial actions
3. We will ensure that we develop community led proactive primary care that works within the locality and is sensitive to local needs and strategy
4. We will ensure that we have continued positive dialogue with the commissioners around our delivery, our future plans and how we can support commissioners in the delivery of new schemes
5. We will always be open and transparent and accountable for our actions.