The primary care regulatory landscape has changed dramatically over recent years.
- Practice contracts are now managed by the local CCG
- GP involvement with commissioning has passed from the PCT to the CCG including new priorities impacting upon primary care.
- There is an on-going need for financial savings
- Powerful private sector competitors have entered the market nationally, notably for community services.
- The changing patient profile of older patients as well as demands to improve health outcomes means we are unable to continue to deliver all traditional services in the same way effectively
- Working together will enable sharing of best practice; bring economies of scale and better use scare staffing resources efficiently.
- By being pro-active we will be seen as an employer of choice in the local health economy.
The demographic landscape continues to evolve along a now well defined trajectory, with an ageing population and increasingly more ethnically diverse and disadvantaged. Patient expectations are rising inexorably and workload is becoming more complex. At the same time, recruiting GPs, and retaining older ones, is becoming more difficult.
- Retain local knowledge and existing patient-doctor relationships.
- Improve quality and reduce variation in service delivery.
- Increase number of allied health professionals and complementary disciplines working with General Practice to ensure patient sees professional most appropriate to their needs
- Focus on prevention and forward planning and less on reacting to illness.
- Address workload and capacity issues.
- Develop role which primary care can play in the move of services from hospital closer to patients.
- Meet challenges identified by practices such as recruitment.
- Share comparative data and best practice to improve the quality of care for patients.
- Utilise new technologies to deal with demand.
- Reduce duplication.
- Build an organisation that is able to exist beyond the next NHS reorganisation.
- Develop a culture that has a focus on improving patient care, is democratic, open and transparent.
The fundamental idea behind Collaboration is that the new challenges outlined above are best faced together. The proposed South Tyneside Collaboration has four objectives and each will have a detailed annual workplan with clear outcomes:
1. Support & strengthen primary care in South Tyneside
- Promote and assist practices to improve quality and reduce variation in service delivery via a group Quality team sharing best practice and eliminating waste.
- Assist GP practices to address workload & capacity e.g. clinical support group sessions such as diabetes, telephone triage, practice skill mix, signposting.
- Develop the role which primary care can play in the move of services from hospital closer to patients in the community.
- Help with challenges identified by practices - GP recruitment, bank staffing
- Sharing best practice.
- Replicate the system of locum chambers, successfully used in Cambridge to create a large pool of high quality locums.
- To work with practices when opportunities for new work emerge.
2. Support practices to maintain existing or generate new income streams and reduce costs
- A common high quality approach to certain new work such as DES, frailty, BOS.
- Helping practices to reduce operating costs such as locum hire, insurance and improve the quality of care for patients with long term conditions by sharing comparative data and best practice.
- Sharing some back office services such as CQC, HR policies telephone answering services.
- Reducing the duplication of all practices doing the same task e.g. common approaches to recruitment and sharing staff.
- Offering pharmaceutical companies wanting to conduct research a very large pool of patients.
- Offer a credible bid where new or existing primary care services are put out for tender by the CCG.
3. To support our CCG to meet its objectives
- Helping to identify cost savings.
- Promote universally high quality primary care in South Tyneside.
- Assisting where CCG objectives require primary care involvement.
4. To build a sustainable organisation
- That has strong support from practices.
- Is financially independent.
- Able to exist beyond the next NHS reorganisation.
The Collaboration will be open to all and governed by a members’ agreement.
The organisation will be managed by an elected Board of six with an option for a co-opted member. The Board will elect the Chair. When votes are required from members, each practice will have one vote. The Board will adopt a conflict of interest policy reflecting best practice and BMA/GMC guidance.
A Quality team will regularly examine data on complaints, activity and outcomes relating to activity delivered directly and indirectly by the collaboration.
The Collaboration will in time deliver services and employ staff directly. It will support staff development in line with delivering excellent clinical services.
The collaboration recognises the importance of robust and effective technology in delivering modern healthcare services.
To that end it is agreed that all member practices will utilise the same clinical record – provided currently by EMIS. Where cross clinical activities stake place EMIS Enterprise will be the usual tool to share patient information, diaries and tasks.
Wherever possible the collaborative will embrace new technology solutions to aid patients – including online access for results, booking and consultations – including email and web consultations.
The introduction of patient self-testing and drug administration will be developed in line with NICE guidance and advances in training, ease of use and governance arrangements.
Key Performance Indicators (KPIs) will be extracted from the single data set to ensure consistent, reliable information is available to the Board and member partners in developing and delivering services. This will include checks on quality service provision, activity levels and matching capacity to demand where required. Such data will be shared in an open and transparent way with commissioners and stakeholders.