Sustainability and Transformation

Background

The various challenges facing the health and social care system nationally are well rehearsed and obviously Doncaster is no exception to these. The latest public health profile states that “the health of people in Doncaster is generally worse than the England average. Doncaster is one of the 20% most deprived districts/unitary authorities in England and about 24% (13,300) of children live in low income families. Life expectancy for both men and women is
lower than the England average.”

The local health and social care system is faced with trying to improve outcomes and reduce inequalities at a time of increasing financial and workforce pressures. Alongside the obvious difficulties this poses, it does provide new opportunities by creating the environment and stimulating the appetite for new approaches and ways of working which have the potential to transform the way care is provided.

Plans with a direct and indirect impact

From a general practice perspective there are 4 main plans/strategies that will influence what care looks like over the coming years:

  1. The Primary Care Strategic Model, also sometimes referred to as the Four Pillars, sets out our vision for developing primary care in Doncaster. It places the person at the centre with a focus on care coordination, quality and safety running through the individually commissioned pillars. The model links in closely with the GP Forward View
  2. The General Practice Forward View was a document published by NHS England in April 2016 that came with a commitment of “an extra £2.4 billion per year to support general practice services by 2020/21” with the aim of “improving patient care and access and investing in new ways of providing primary care.” The plan was developed with the Royal College of General Practitioners and Health Education England and contains many steps to:
    • channel investment
    • grow and develop the workforce
    • streamline the workload
    • improve infrastructure
    • support practices to redesign their services to patients.

As a lot has happened in the time since the document was published and it is tricky enough for us to keep track of the different strands, we’ve gone through what’s happened nationally and locally so far, what is coming next and what we’re waiting to find out more about in the GP Forward View page.

3. The Doncaster Place Plan is a joint strategy produced by Doncaster’s commissioners (the CCG, DMBC, Doncaster Children’s Services Trust) and representatives from the major local healthcare providers (DBTH FT, RDaSH FT, FCMS; general practice was represented by the LMC and emerging GP federations). It puts general practice and primary care at the heart of health care delivery with close links to services delivered across the four neighbourhoods that community and social care services are aligning to.

The pillars of the Primary Care Strategic Model already/will strongly support the prevention and early help cohort, we’re already seeing new Rapid Response Pathways as part of the intermediate care cohort, and the recently launched Your Life Doncaster is the front end for the new Community Led Support model that will help support enablement and recovery.

4. The South Yorkshire and Bassetlaw Sustainability and Transformation Plan (STP) is one of 44 STPs nationally which between them cover all of England. The NHS and local councils have come together to develop proposals and make improvements to health and care. The proposal sets out the vision, ambitions and priorities for the future of health and care in the region. It covers Doncaster, Sheffield, Barnsley, Rotherham and Bassetlaw.

The full plan is available for anyone who wants to go through it in detail. There is also a much briefer summary. Below is the plan on a page from the full plan – this highlights the 3 gaps that STPs are intended to address and that the region is looking at a £571 million health and social care gap if things carry on as they have done.

Practices working at scale

These plans, along with what is happening at a practice level in terms of managing current workload (both clinical and administrative) and the issues many are having with recruiting and/or retaining, has seen an increase in support and incentive for practices to work more collaboratively and at larger scale. The RGCP has a General Practice at Scale programme which includes a learning network. Across the country there are many examples of this at scale working over the last few years, often having taken different paths to arrive at different organisation types with different aims and visions.

There has been a noticeable ramping up of the drive towards this nationally with much of the non-financial support (e.g. Releasing Time for Care Programme) outlined in the GP Forward View either being explicitly or implicitly targeted at groups of practices rather than individual ones. Where there is funding for particular parts of the GP Forward View, e.g. upskilling reception and administrative staff, if they were to be just split up per practice the pots of money look smaller than what is needed to make meaningful change.

The new care models work by NHS England, including the Vanguards, is now in its 3rd year and there is now specific guidance on the ways that practices may contractually participate in an MCP (multispecialty provider community provider). In this document the description of “virtual” MCP, the least integrated of the 3 models, states that:

  • core general practice remains commissioned under GMS, PMS or APMS contracts
  • practices would sign an “alliance agreement” with commissioners and other providers to facilitate joint working, which sits over the top of (but does not supersede) traditional contracts
  • this builds on the growth of GP federations, which represents a stepping stone to this model
  • in this model a new MCP Contract is not awarded.

The CCG’s response to this national drive and increasing local concerns about the resilience of Doncaster General Practice as a whole (as well as individual practices either highlighted by pieces of work or who have approached us or the LMC) has been a more directive one of wanting our practices to work towards a single GP Federation covering all of Doncaster if possible. We feel such a federation would:

  • support our transformation plans by giving general practice a strong provider voice around the table as part of the Accountable Care Partnership required to ensure effective delivery of the Doncaster Place Plan
  • increase support to practices in with their sustainability and transformation where they are struggling to do so themselves
  • provide a single point for discussion and negotiation for matters of primary care provision
  • put us in a stronger position to access new / make the best use of existing financial and non-financial support that comes from regional or national sources

We realise that reaching this point still requires a considerable amount of work and support, although there has been much progress over the last year. We are using leftover funding from the General Practice Resilience Programme in 2016/17 to have an external party facilitate initial discussions and develop a work programme between the 4 collaborations/federations in Doncaster with the aim of forming a single Doncaster-wide federation. The LMC are involved with the work to make sure that practices that are not currently affiliated to any of the collaborations are represented. A first workshop took place at the start of February, followed by one in early March and a concluding workshop is being held on 30th March. There has been considerable hard work put in by those involved between the meetings to make sure they are representing the views across Doncaster and the outputs from the first 2 workshops have been circulated to all practices. The outcome of the final workshop including the workplan will have an influence on how things generally develop over the coming months and years.