7 day working and the Prime Minister’s Challenge Fund

• Aim : To consider the localisation of the 7 day national directive, but in the context of a workable, sustainable solution for Gloucestershire that takes consideration of the pressures felt in Primary Care

• Format : • Overview presentation • Discussion on key areas• Feedback and summarise

Pressures on Primary Care

Primary Care

Constrained funding growth

Workforce pressures

Rising Patient Consultations

Rising prevalence of

chronic disease

History of Estates and IT

under-development

• Primary Care funding c.£9.3bn in 2013/14, c.8.4% of total NHS budget

• Trend of reducing general practice funding since 2004/05, which is currently forecast to continue (Deloitte 04/2014)

Pressures on Primary CareConstrained

funding growth

• Workforce growth from 1995 to 2011 (Centre for Workforce Intelligence (CfWI), 2013) demonstrates challenge :

• Consultants : c.100% growth• GPs : c.29% growth

• 22% of WTE Gloucestershire GPs are over 55

• We have a further 21% between 50-54 (17% nationally) with 8% under 35 (13% nationally)

Pressures on Primary Care

Workforce pressures

Increase in consultation rates by age demonstrates increasing consultations for elderly patients:

Pressures on Primary Care

Rising Patient Consultations

• Longer average consultations, more consultations and more complexity than decade ago (CfWI, 2013)

• Number of people with multiple morbidity estimated to grow from c.1.9m in 2008 to c.2.9m by 2018 (Salisbury et al. 2011)

• 20% of Gloucestershire’s registered population are aged 65 and over, compared to 17% nationally

Pressures on Primary CareRising Patient

Consultations

Rising prevalence of chronic disease

• We want to ensure patients receive care in safe, accessible, suitable premises

• Investment in primary care estate lagged behind secondary care capital spend (NHSE, 03/2014)

• General practice often still in inadequate buildings, offering limited facilities, with little (if any) ability to expand to offer more services

Pressures on Primary CareHistory of

Estates and IT under-

development

• Reduced funding year-on-year

• Workforce challenges, specifically relating to our GP workforce age ranges

• Increased demand from an ageing population

with increased multiple morbidities

• Premises and IT issues

• Current structures inhibit effective change

Summary of the Challenges

• Aim of Fund :– test new models of care – deliver 7 day services

• 20 pilots selected nationally• Opportunity to use £300k for 14/15• Potential for significant investment next year

Prime Minister’s Challenge Fund

GCCG view : change shouldn’t be for change’s sake – must be sustainable

and workable

By commonality between schemes:• All successful bids included 7 day working,

predominantly via federation

• Online functionality (booking, appointments)

• More patient services within federations

• Single telephone line to Primary Care

• Care Navigators / co-ordinators

Key Themes of Successful Bids

• Seven day Primary Care - what model(s) could work in Gloucestershire?

• Models for discussion (5 minutes each):– Federated (5/6 practices collaborating to deliver)– Flexibly using extended hours DES– Locality delivery model– Urgent Care Centres (combining MIU; MIIU;

GHAC); exploring ‘hot’ and ‘cold’– Any other ideas

Discussion

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• Key points identified

• Next steps will be communicated to localities

• Any questions to raise with panel at 15.55?

Feedback

Thank-you for your contribution