ITEM 8 Primary Care Transformation
North Lanarkshire Council · 25 September 2024
Back to Health and Social Care Integration Joint Board — 25 September 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 8 SUBJECT: Primary Care Transformation TO: Integration Joint Board Committee Lead Officer for Report: Dr Mark Russell, Medical Director, South Lanarkshire University Health & Social Care Partnership Author(s) of Report Dr Mark Russell, Medical Director, South Lanarkshire University Health & Social Care Partnership DATE: 25 September 2024 1. PURPOSE OF REPORT To outline the progress made in developing an action plan for Primary Care Transformation. This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☐ Reviewed By: ☐ Endorsed By: ☒ South Lanarkshire IJB
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2 3. RECOMMENDATIONS It is recommended that the IJB: [re (1) Recognise the challenges facing General Practice in particular and the current measures in place to support. (2) Acknowledge the whole system change required to ensure sustainable Primary Care provision for the population of Lanarkshire. 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The legacy of historical primary care investment in Lanarkshire over the last 30 years - with Lanarkshire is now 12% below the National Resource Allocation Formula share of Scottish GP practice spending - has resulted in it now having the lowest primary care capacity in Scotland (whole time equivalent number of GPs 30% below national average). 5.2 This has resulted in challenges for patients in accessing General Practice, both: Being able to contact their GP practice. Getting a consultation with an appropriate clinician once they have contacted the practice. 5.3 General Practice access is a national issue but because of its relative shortage of GPs, Lanarkshire is at the forefront of this challenge. 5.4 There is no national excess of GPs to attract to Lanarkshire, and the low historic investment - in both General Practice and supporting infrastructure, including interface pathways - makes it unlikely that it would be possible to attract them even if there was. 5.5 The Primary Care Improvement Programme (PCIP) has delivered significant additional resource, with a pharmacotherapy service available to every practice, Treatment rooms delivering Community Treatment and Care services available across every locality and responsibility for vaccination having been taken from General Practices and moved to delivery by a central service. In addition, new roles such as Community Link Workers have been Yes ☐ No ☒ N/A ☐
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3 made available to all practices. However, these interventions have not succeeded in fully mitigating the challenges posed by the mismatch of GP supply and demand (either nationally or locally), with the key national deliverables not well aligned with drivers for General Practice access. 5.6 A comprehensive three horizons plan has therefore been developed to address the challenges in General Practice: Improve recruitment and retention to Lanarkshire practices. Work with all Lanarkshire practices to focus on improving their access within existing resources. Develop alternative access routes to services for patients outside of General Practice. 5.7 A proactive support infrastructure has been created to assist practices who identify that their sustainability is compromised. Senior officers meet on a weekly basis to monitor practices with ongoing challenges and to ensure that the Health Board’s resources are utilised to address issues and support change within individual practices. 6. PRIMARY CARE REFORM 6.1 The future for the provision of Primary Care lies not just with independent contractor services, but a broad range of services which provide care which meets the key principles of Primary Care – services which provide first contact care in a way which is comprehensive, co-ordinated, and provides continuity of care for patients. 6.2 Alongside Mental Health Planned and Unscheduled care, Primary Care is a key component of Lanarkshire’s new healthcare strategy, Our Health Together which has previously been shared with the IJB. 6.. Given that importance of primary care to the overall healthcare system, it is imperative that change is outcome focused. Key outcomes are: 6.3.1 Right person, right place, first time Ensure that patients can get access when they perceive they have an urgent need. Ensure that continuity of care is maintained and that GPs are able to follow up patients in a consistent way. Minimise demand on other parts of the Health system which should be dealt with in primary care (failure demand). 6.3.2 Patient satisfaction Reduce waiting times for general practice. Ensure that non-GP primary care services deliver to patient need and primary care values, to ensure that patients do not present subsequently to general practice for the same problem.
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4 6.3.3 Effective and efficient systems Ensuring that GPs have timely access to diagnostics, supported by real- time specialist advice where appropriate, to ensure that patient journeys are completed within primary care where this is appropriate. Ensuring that GP have access to leading-edge Digital Systems to enable them to manage their patients effectively. 6.4 There are three key areas where significant change will be required to preserve access to primary care. 6.5 Firstly, while many services currently have elements of patient self-referral, it is evident from a recent Patient Voice project - where over 1000 patients were contacted about their experience of accessing primary and secondary care services - that there is very variable population understanding of the myriad of available pathways. If future alternatives to General Practice care are to achieve traction, a coherent model which can be easily understood is essential. 6.6 A codesign process will therefore be required to develop an understanding of how new services should be designed and how existing core services can the redeveloped. In the first instance, redevelopment of core services will examine how they can offer more comprehensive services within their exiting scopes, so that there is less reliance on General Practice to provide senior clinical decision-making. However, there is likely to be further opportunity for broadening of scope within those services broad service purpose. In practical terms, District Nursing Teams will be strengthened with Advance Practitioner support funded from Primary Care Improvement Fund (PCIF) to improve the management of patients on their case load, but in the longer term, they could become the hub service leading management of all patients with significant frailty within a locality. 6.7 Over the last year, there has been significant investment from PCIF in Musculoskeletal (MSK) Physiotherapy. In this first instance this will help to reduce waiting lists, but it is planned that over time, this service will take first- contact responsibility for the 16% of GP consultations which currently result from MSK problems. 6.8 Secondly, many parts of the healthcare system have come to rely on General Practice as an intermediary to connect care and to provide prescribing or investigation requesting close to the patient. Whilst this has provided some benefits it is important to understand the implications of this now. Data collected in a snapshot exercise in April 2024 showed that between 7.4% and 8.7% of General Practice capacity is absorbed by this activity. This is equivalent to 1900-2200 appointments per week – with representing capacity could be freed up by better whole system processes and digital integration. In addition, 19% of GP consultations were impacted by providing follow on care
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5 for other services. A whole system programme of change will be required to bring about this change. 6.9 Finally, the combination of necessarily altered modes of care during the pandemic and workforce challenges has proved disruptive to patterns of care within General Practice. Evidence from a number of practices who have taken part in the Primary Care Access Programme shows that there are opportunities to improve access through improvements in contact processes and efficiency gains through improved continuity of care. There is a challenge to deploying this at scale and it will require close working with the GP Sub- Committee and the local general practice community. Opportunities to use technology to improve co-ordination of care and provide new means of communication for those who wish to use it will also need to be explored. To complement this work, a robust communications plan with clear, transparent and honest key messages on the future of general practice will be required. 7. CONCLUSIONS 7.1 Given the above, the focus for 2024/25 an action plan is in place targeting four key areas of work: Maximising the productivity and effectiveness of existing PCIP resource. Development of a programme of work to ensure that is the existing capacity of General Practice is used optimally, and exploration to identify technology which could assist and can be deployed across all practices. Utilising the infrastructure of the new NHS Lanarkshire Interface Directorate to drive the whole system change required for the codesign of new pathways into secondary care and ensure that community resources, such as Community and Treatment and Care facilities are easily available to Secondary Care without the necessity to involve General Practice. A programme, working with third sector groups, to codesign new (managed service) first contact services which are comprehensive, co- ordinated and provide continuity of care for patients where appropriate. 7.2 Oversight of the delivery of this action plan sits with the Primary Care Strategy Board, chaired by Director of Health and Social Care, South Lanarkshire University HSCP. As a core workstream of NHS Lanarkshire’s Our Health Together Strategy, programme management support is being provided by the NHS Lanarkshire Property, Planning and Performance Directorate. 7.3 Supporting workstreams will undertake a communications and engagement exercise across primary and secondary care and ensure that future Digital plans align with Primary Care strategic goals – such as easy access to patient records across all primary care services. Initial investment has been made using end-of-year PCIP funding, with the agreement of Scottish Government, in the development of a Digital Front Door platform to support access to new and redesigned primary care services.
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6 8. IMPLICATIONS 8.1 Other Implications 8.1.1 The contents of this report are material to the delivery of the IJB Strategic Commissioning Plan 2023 – 2026, notably the following key ambitions: • Do the right thing first time • Increased focus on prevention, early intervention and tackling inequalities by working with communities and people • Develop and support a workforce for the future 8.2 Equality Impact Assessment and Consultation Arrangements 8.2.1 An Equality Impact Assessment will be carried out as necessary within workstreams. 8.2.2 The voice of patients will be centred in the redesign programme. An exercise involving telephone contact with over 1000 patients has already been completed. A general communications and engagement plan was developed to support the project, with a range of stakeholders engaged throughout and at key points (including GPs, pharmacists and patients). 8.2.3 Communities and stakeholders will be appropriately involved in service redesign processes. 9. NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒
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7 10. ASSOCIATED MEASURE(S) 10.1 Employee Implications 10.1.1 Staff and Trade Union colleagues will be appropriately involved in service redesign processes. 10.2 Financial 10.2.1 Current financial challenges make service redesign challenging and also vital to ensure continued high-quality care. 10.2.2 The PCIF is now fully committed and therefore ensuring maximal efficiency in funded workstreams is key to enabling funding to be released to fund broader programmes of change. This paper has been reviewed by Finance: Yes No N/A 10.3 Risk Assessment / Risk Management Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 10.4 Engagement & Participation Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes ☒ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is
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8 shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 11. INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A 12. BACKGROUND PAPERS None. 13. APPENDICES None.
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9 CHIEF ACCOUNTABLE OFFICER (or Depute) Professor Ross McGuffie Chief Officer, Health and Social Care North Lanarkshire Members seeking further information about any aspect of this report, please contact the following: Dr Mark Russell, Medical Director, South Lanarkshire University Health and Social Care Partnership email: mark.russell@lanarkshire.scot.nhs.uk
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10 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed