What Does The Future Hold For At-Scale Primary Care?: DR Robert Varnam

What does the future hold
for at-scale primary care?
Dr Robert Varnam
Head of General Practice Development
NHS England
@robertvarnam
#GPforwardview
#GPforwardview
Asking the right questions
 Is there something meaningful for us to do?
 What size should we be?
 How do we realise the benefits of scale?
 What capabilities will we need?
#GPforwardview
#GPforwardview
Multispeciality Community Provider contract
Virtual MCP
Alliance contract, overlaid on existing contracts
Partially integrated
Pre-procurement of community services (MCP + GMS)
Fully integrated
Hybrid: NHS Standard Contract & primary medical services
Single, whole population budget for all services covered
New performance element (replacing CQUIN & QOF)
Risk share for acute activity
bit.ly/MCPframe1
#GPforwardview
UK general practice is one of the world’s most comprehensive embodiments of the
founding principles of primary care…
Holistic perspective understanding

the whole patient not just a disease
Personal care built on a

relationship from cradle to grave First port of call and
central point of care
for all, for life
Comprehensive skills to
diagnose & manage almost anything
Community based responsible for

prevention and care of a registered population
Personal and population-orientated primary care is central …

if general practice fails, the whole NHS fails. Simon Stevens, General Practice Forward View
www.england.nhs.uk @robertvarnam
Broader skillmix
Population wellbeing management
and holistic person-centred care
provided by a multiprofessional team
led by the GP, supported by at-scale
collaboration and efficiencies.
At scale
Emergency
care
Self Self
Care management /
social
prescribing Collaboration
with specialists
www.england.nhs.uk @robertvarnam
#GPforwardview
 Is there something meaningful for us to do?
#GPforwardview
What is the ideal size?
4 400
Clarity Alignment
Commitment Priorities
Agility Partnerships
We need
the best of
both worlds
@robertvarnam
STP footprint: 300k-2m
Workforce & infrastructure planning
Large scale service reconfiguration
Major partnerships & shifts in priority
MCP: 100-350k
Organisational infrastructure & governance
Specialist staff & services
Employment & career development
Model design (population management, care models)
Strategic partnerships
Hub/Home: 30-60k
Acute care
Locality-tailored services
Shared MDT
Place of ‘belonging’
Core team: 3-4k

Coordinated, complex
multidisciplinary care
Continuity
#GPforwardview
#GPforwardview
 What size should we be?
#GPforwardview
Working at scale: Opportunities for practices
#GPforwardview
 Staff pooling
• nurses, reception & clerical staff, sessional GPs
 Overflow support
• phone consultations
• access hub (phone +/- face-to-face)
• home visiting
#GPforwardview
 Purchasing
• Indemnity
• Supplies
• Utilities
 Shared functions
• Policies & procedures
• Procurement
• Correspondence management
• IM&T (eg support & maintenance, intranet, web, social media)
 Specialist functions
• HR
• Finance
• Clinical governance
• Business intelligence
#GPforwardview
 Planning
• Workforce
• Infrastructure development
• Service reconfiguration
• Public health
 Provision
• Acute care
• Community pharmacy
• Dentistry
• Optometry
• Social care
• Housing
• Welfare
• Voluntary sector
#GPforwardview
 Traditional healthcare roles
• Pharmacists
• Specialist nurses
• Physiotherapists
• MH therapists
• Paramedics
 Wellbeing workers
• Social workers
• Care navigators
• Health trainers & coaches
• Welfare advisors
#GPforwardview
 QI expertise
 Analytics
• Population health analytics
• Priority setting
• Benchmarking
• Realtime measurement
 Project management
#GPforwardview
 HR
 CPD
 Career development
• Leadership
• Mentoring
• Service improvement
• Research
#GPforwardview
 What size should we be?
 How do we realise the benefits of scale?
#GPforwardview
Capabilities for the future
Leadership Improvement Business At-scale

working
Interdependent capabilities for leaders & organisations
Creating shared Patients as

Team leadership Governance
purpose partners
Strategic
Operations
planning & Process design Contracts
management
partnerships
Leading through Using data for

HR Workforce
change improvement
Rapid cycle Business

Being a leader IT
change intelligence
@robertvarnam
www.england.nhs.uk/gpdp
10 High Impact Actions Local Time for Care General Practice

to release time for care programmes Improvement Leaders
• Bespoke 9-12 month • At least 400 free places a
programme to support a group year for three years.
of practices to implement
• Skills and confidence in
innovations that release time
designing and implementing
for care.
improvements within the
practice rapidly and
• Training for reception and sustainably.
clerical staff, for active
signposting and document • RCGP Supporting
management (£45m over 5 Federations Network and
years). NHS Collaborate (NAPC &
• Funding towards purchasing NHS Alliance) for leaders of
• Local showcase events online consultation systems at-scale primary care.
• Web resources (£45m over 4 years, from • Funding facilitated peer
• Fortnightly webinars 2017). networking for practice
• Network of champions • CCG transformational managers of all 7,800
support (£171m over 2 years, practices, with support to
from 2017). develop @robertvarnam
professional skills.

What Does The Future Hold For At-Scale Primary Care?: DR Robert Varnam

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What Does The Future Hold For At-Scale Primary Care?: DR Robert Varnam

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What does the future hold

for at-scale primary care?

 Is there something meaningful for us to do?

 What size should we be?

 How do we realise the benefits of scale?

 What capabilities will we need?

 Is there something meaningful for us to do?

 What size should we be?

 How do we realise the benefits of scale?

 What capabilities will we need?

Holistic perspective understanding

Personal care built on a

Community based responsible for

Personal and population-orientated primary care is central …

 Is there something meaningful for us to do?

 What size should we be?

 How do we realise the benefits of scale?

 What capabilities will we need?

 Is there something meaningful for us to do?

 What size should we be?

 How do we realise the benefits of scale?

 What capabilities will we need?

Core team: 3-4k

 Is there something meaningful for us to do?

 What size should we be?

 How do we realise the benefits of scale?

 What capabilities will we need?

 Is there something meaningful for us to do?

 What size should we be?

 How do we realise the benefits of scale?

 What capabilities will we need?

 Is there something meaningful for us to do?

 What size should we be?

 How do we realise the benefits of scale?

 What capabilities will we need?

Leadership Improvement Business At-scale

Creating shared Patients as

Leading through Using data for

Rapid cycle Business

10 High Impact Actions Local Time for Care General Practice

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