Appendix 1 24.8.22 IJB Presentation Primary Care Modernisation Update
Argyll and Bute Council · 24 August 2022
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 24 August 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Primary Care Modernisation Update Evan Beswick, Head of Primary Care, Dr AlidaMacGregor, GP Principal, KylesMedical Centre and Clinical Lead – CowalLocality, Denise McDermott, ProgrammeManager – Primary Care Modernisation IJB Development Session, 24th August 2022
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Historical Context • Since the inception of the NHS, the vast majority of General Practiceshave operated on an independent contractor model. • Each practice holds a General Medical Services (GMS) contract with the Board and receives an allocation of fundingbased on a nationally agreed formula. • TheGMS contract outlinesthe services which the Practice must providebut allows for flexibility in how this is achieved. • Practices are therefore free to employ a variety of staff and set up servicesin a way which they feel best meets the needs of their patient population. • Increasing pressure, particularly on urban practices, lead to a wholescale redesign of the GMS contract.
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2018 General Medical Services Contract • This phase of the new GP contract introduced in 2018 was a planned transition over 3 years extended to 4 years ending March 2022. • Funding was provided for new staff who would be employed by Argyll and Bute HSCP. • Staff would be attached to practices and clusters to reduce GP workload. • Significant changes in the new contract included: • The role of the GP as an Expert Medical Generalist co-ordinating a multi-disciplinary community care team • A new formula for calculating the core funding each practice receives • Significant investment in a number of services which NHS Boards and Integration Authorities are expected to put in place to support the work of General Practice
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Scottish Workload Allocation Formula • New funding formula which altered weighting for particular demographic factors • Removed the rural weighting, negatively impacting majority of Practices within Argyll and Bute • Income topped up to previous level with 'Practice Income Guarantee' • Significant damage to morale as perceived 'life support' funding and no recognition of complexities of providing Primary Care in Remote and Rural areas
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Memorandum of Understanding • The original MOU set out an agreement between GP practices andintegrated authorities to deliver a specified set of services across 6 KeyPriority areas with an expectation that they would transfer to theHSCP byMarch 2021. • Vaccination Transformation • Pharmacotherapy • Community Treatment and Care • Urgent Care • Community Link Workers • Additional Professional Roles • Musculoskeletal First Contact Practitioner • Community Clinical Mental Health Professionals
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Memorandum of Understanding 2 (2021) • Recognised the challenge of delivering all 6 key priority areas against the background of the Covid pandemic. • 3 key areas of implementation were highlighted in a revision of priorities • Vaccination Transformation and CTAC (Community Treatment and Care) • Pharmacotherapy
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Argyll & Bute HSCP 31 GP Practices, 28 are considered to be remote and rural. 103 GP principals, 25% of Argyll and Bute GPs are over 56 years of age. 89,400 Population 4 Localities/ Locality Planning Groups and 6 GP Cluster Groups 4 GP run Community Hospitals, including A&E Continued requirement for GP Out of Hours cover on Islands and Remote Areas Practice list sizes range from 142 patients on the Island of Colonsay to 11,149 patients in Lorn Medical Centre, Oban Argyll and Bute is challenged by recruitment and retention difficulties. 4 GP Practices, Kintyre Medical Group, Carradale, Kilcreggan and Garelochhead are now managed by the HSCP
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Argyll and Bute HSCP 2022-2023 Primary Care Improvement Fund Budget - £3,199,000 Immunisations and Community Treatment and Care (CTAC), 35% Pharmacotherapy , 29% First Contact Physiotherapy , 15% Primary Care Mental Health, 17% Community Link Workers, 4% Immunisations and Community Treatment and Care (CTAC) Pharmacotherapy First Contact Physiotherapy Primary Care Mental Health Community Link Workers The PCIF Budget outlined above is subject to additional investment of Scottish Government Sustainable Vaccine Funding of £1,804,000 which will supplement the Immunisation and Pharmacy Teams in addition to supporting Boardwide and Vaccine Venue costs.
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Rural Flexibility February 2022 – Approval was obtained from the Scottish Government to exercise rural flexibility in Argyll and Bute. • Full Flexibility - 4 small island practices (Coll, Colonsay, Jura and Tiree) • Partial Flexibility - 14 remote and rural practices (Mull and Iona – 4 GP Surgeries, Islay – 3 GP Practices, Bute, Port Appin, Easdale, Lochgoilhead, Strachur, Kilmun, Tighnabruaich, Carradale, Kilcregganand Arrochar) • Flexible options • Full – Practices continue to deliver vaccination and CTAC services • Partial – Co-delivery of services by the practices and HSCP Teams
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Transfer of Vaccination and CTAC Workload to HSCP from GP Practices Transferred on 01/04/2022 Transferring on 01/07/2022 Transferring on 01/09/2022 Partial Transfer by 31/03/23 Practice Name Partial Flexibility COVID Flu Childhood & Infant Adult Vaccination Maternity & Neo-Natal School Age/Young People Travel CTAC Taynuilt Medical Practice 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Lorn Medical Centre 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Port Appin Surgery Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Easdale Medical Practice Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Mull & Iona Medical Group Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/04/2022 01/07/2022 Yes Campbeltown Medical Practice 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes The Furnace/Inveraray Surgery 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Tarbert Medical Practice 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Kintyre Medical Group 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Carradale Surgery Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Bowmore Medical Practice Yes No Port Ellen Surgery Yes No Rhinns Medical Centre Yes No Lochgilphead Medical Centre Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Dr G Hall & Partners 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Church Street Surgery 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Cowal Medical Practice 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Lochgoilhead Medical Centre 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet The Bute Practice Yes No Strachur Medical Practice Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Riverbank Surgery Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Kyles Medical Centre Yes 01/04/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Not Agreed Yet Garelochhead Medical Centre 01/04/2022 01/09/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Millig Practice 01/04/2022 01/09/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Dr B McLachlan & Partners 01/04/2022 01/09/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Arrochar Surgery Yes 01/04/2022 01/09/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes Kilcreggan Health Centre Yes 01/04/2022 01/09/2022 01/09/2022 01/04/2022 01/04/2022 01/07/2022 Yes
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Primary Care Pharmacotherapy Service Argyll and Bute HSCP Pharmacotherapy Team – 7.80wte Pharmacists, 4.00wte Pharmacy Techniciansand 2.40wte Pharmacy Assistants Pharmacists Pharmacy Techniciansand Assistants Level 1 (Core Service – Partial Provision to 20 of 31 GP Practices) Authorise/Action Acute Prescribing Requests Repeat Prescribing Requests Hospital Discharge Letters Safety Reviews/Recall High Risk Medicine Monitoring Non Clinical Medication Reviews Arrange Clinics Manage Prescribing Requests Manage Repeats Manage Serial Prescribing Action Medicines Reconciliations Level 2 (Additional – Advanced Service – Partial Provision to 23 of 31 GP Practices) Medication Reviews Resolving High Risk Medicines Problems Level 3 (Additional – Specialist Service – Partial Provision to 6 of 31 GP Practices) Polypharmacy Reviews Specialist Clinics – Direct Patient Engagement
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Physiotherapy First Contact Practitioners (FCP) – 7.00wte providing a service to 9 of 31 GP Practices • Focused on Musculoskeletal (MSK) Conditions • MSK conditions frequently cause repeat appointments with GPs • Majority of GPs MSK Caseload can be Safely and Effectively Managed by FCPs • Extended Scope Physiotherapists in Each Locality Primary Care Mental Health Workers – 11.65wte providing a partial service to 26 of 31 GP Practices • Access to Expert Assessment and intervention for Adults with mild to moderate mental health difficulties • 1 in 3 GP Appointments involve a Mental Health Component – Common Alignment with Long Term Conditions • Locality Teams – Primary Care Mental Health Nursing, Occupational Therapists, CBT Therapists, Art Therapy and Guided Self-Help Workers Additional Professional Roles
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• Contract awarded to an independent service provider ‘We Are With You’ for engagement of 5.00wte Community Link Workers to provide a service to 11 of the 31 practices in Argyll and Bute • The service builds on Existing and Developing Relationships between the HSCP and Third Sector Organisations • Coordinates Social Prescribing Solutions supporting people to live well through strengthening connections between community resources and primary care • Interface with GP IT Systems to Enable Referrals and for GP to Monitor Patient's Progress Community Links Workers
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Next Steps • The Autumn/Winter Covid and Flu vaccine campaign will be delivered to the patients of 23 of the 31 Practices in Argyll and Bute by HSCP Primary Care Nursing Teams • ‘Week of Care’ audit analysis by Public Health Scotland to support and inform the development of local nursing teams • Transfer of further vaccination categories from GP practices to HSCP teams • Seek solutions for lack of space in GP practices to enable multi disciplinary teams to continue to remove workload from GPs • Further development of primary care teams to include the Mental Health and Wellbeing agenda • Address ongoing challenges of Covid-19