Transforming Primary Care in London: A Strategic Commissioning Framework Transforming London’s health and care together NHSE brochure 2015 FINAL_Layout 1 18/03/2015 16:20 Page 2 Acknowledgement 2 This Strategic Commissioning Framework is • The Clinical Expert Panels which carried presented by the London Primary Care out the early innovative thinking and Transformation Board and Primary Care provided some of the underpinning evidence Transformation Clinical Board. It has been and case studies which shaped the developed by clinicians, commissioners, patients development of the specification within and other partners across London. this Framework. • The Primary Care Transformation Board Members of the team and the governance which provided strategic oversight and boards are listed in Appendix 2; however it is testing from across the health and social not possible to name everyone individually. The care system. team would like to thank everyone who has contributed to drafting, testing and refining this • The Primary Care Transformation Patient Framework, as without these contributions, Board which provided insight and direction. production of this Framework would not have • The Primary Care Transformation Clinical been possible. In particular, we would like to Board which provided clinical leadership; extend our appreciation to the members of: tested the rigour and practicality of the specification; and ensured that the specification was ambitious enough to meet the needs of patients in London. • The Primary Care Transformation Delivery Group which supported and tested the development and detail of the key enabler work areas. • The Primary Care Transformation Team who have worked with all the stakeholders and supported development and delivery of this Framework. Acknowledgement NHSE brochure 2015 FINAL_Layout 1 18/03/2015 16:20 Page 2 NHSE brochure 2015 FINAL_Layout 1 18/03/2015 16:20 Page 3 Acknowledgement 2 Contents 3 This Strategic Commissioning Framework is • The Clinical Expert Panels which carried Introduction 4 presented by the London Primary Care out the early innovative thinking and Transformation Board and Primary Care provided some of the underpinning evidence Foreword 5 Transformation Clinical Board. It has been and case studies which shaped the developed by clinicians, commissioners, patients development of the specification within Context 7 and other partners across London. this Framework. Executive summary 11 • The Primary Care Transformation Board Members of the team and the governance which provided strategic oversight and boards are listed in Appendix 2; however it is testing from across the health and social Future general practice 17 not possible to name everyone individually. The care system. What will Londoners notice? 18 team would like to thank everyone who has Models of care 19 contributed to drafting, testing and refining this • The Primary Care Transformation Patient Framework, as without these contributions, Board which provided insight and direction. The service specification 21 production of this Framework would not have • The Primary Care Transformation Clinical been possible. In particular, we would like to Board which provided clinical leadership; Evidence supplement and case studies 21 extend our appreciation to the members of: tested the rigour and practicality of the Service specification development process 22 specification; and ensured that the Further engagement 22 specification was ambitious enough to meet 1. Proactive care specification 23 the needs of patients in London. 2. Accessible care specification 27 • The Primary Care Transformation 3. Coordinated care specification 31 Delivery Group which supported and tested the development and detail of the key The enablers 36 enabler work areas. Local plans to deliver the changes 36 • The Primary Care Transformation Team Co-commissioning 36 who have worked with all the stakeholders and supported development and delivery of Financial implications 38 this Framework. Contracting approach to delivering the service specification 40 Workforce implications 42 Technology implications 49 Estates 52 Provider development requirements 53 Monitoring and evaluation 54 Innovation and improvement 56 Implementation of the Strategic Commissioning Framework 57 Appendix 1: Financial modelling methodology 58 Appendix 2: Team and governance board members 59 Appendix 3: Glossary 63 Acknowledgement Contents NHSE brochure 2015 FINAL_Layout 1 18/03/2015 16:20 Page 4 Introduction 4 Dr Clare Gerada: Clinical Chair for London’s Primary Care Transformation Programme Dr Clare Gerada is a London based GP. She is the immediate past Chair of Council of the Royal College of General Practitioners (RCGP) – the first female Chair for over half a century – and was previously Chair of the Ethics Committee. She established the RCGP’s groundbreaking Substance Misuse Unit and also led on the strategic and logistical delivery of the RCGP Annual National Conference. She has held a number of local and national leadership positions including Senior Medical Adviser to the Department of Health. She is Medical Director of the largest practitioner health programme in the country and she has published a number of academic papers, articles, books and chapters. Prior to general practice, she worked in psychiatry at the Maudsley Hospital in South London, specialising in substance misuse. She was awarded an MBE for services to medicine and substance misuse and was presented with the National Order of Merit award in Malta for distinguishing herself in the field of health. The NHS is unique because of its system of same time we must address the need to improve general practice – a medical home for the coordination of care, access to services and patient – underpinned by a life-long medical take a more proactive approach to our patients’ record. General practice is the first point of health and wellbeing. access for many people, where a high proportion of care is delivered close to people’s homes with I believe that this Strategic Commissioning the potential for a continuous relationship with Framework for Primary Care Transformation in the same clinical team from birth through to the London represents a platform where clinicians, end of life. commissioners, and other stakeholders can build on the work done to date and find solutions to General practice has served patients, the public the challenges for general practice; supporting and the NHS well for over 60 years. It has the healthcare community to make care better delivered accessible, high quality, value for for all Londoners. money care. However our patients are changing, both in the complexity of their conditions and Building on the scale of support we have seen in their expectations. This means that if the NHS for this work, and the additional focus on is going to continue to provide the excellent primary care provided by the NHS Five Year standard of care to which we all aspire, we will Forward View and Better Health for London have to be more innovative. from the London Health Commission, now is the time to make these changes together. Tweaking at the edges is not an option. London needs solutions that will sustain primary care for the next 60 years. We must maintain the integrity and core purpose of general practice (to provide holistic, patient-centred continuous Dr Clare Gerada, Chair of the Primary Care care to patients and their families). But at the Clinical Board Introduction NHSE brochure 2015 FINAL_Layout 1 18/03/2015 16:20 Page 5 Foreword 5 We are pleased to present the Transforming understand the implications of this Framework Primary Care in London: A Strategic and how it fits into the context of wider local Commissioning Framework on behalf of the plans. NHS England and CCGs are now working London Primary Care Transformation Clinical closely together to develop implementation plans Board and Transformation Board. This document for each local area clarifying what they will be provides both a new vision for general practice, delivering in 2015/16 and beyond. and an overview of the considerations required to achieve it. Following drafting of this Framework Transforming primary care is a concept that is throughout 2014, London’s Clinical rapidly gaining momentum as a key priority in Commissioning Groups (CCGs) and NHS England, the NHS – both nationally and in London. Two working with partners (such as the Care Quality important pieces of work were published in the Commission (CQC), Health Education England latter part of 2014, which set the platform for (HEE) and Academic Health Science Networks building on this energy and achieving the (AHSNs)) have been engaging locally to fully ambitions that are developing. 1. NHS Five Year Forward View In October 2014, the NHS published the NHS Five Year Forward View, developed in collaboration with Public Health England (PHE), Monitor, HEE, CQC, and the NHS Trust Development Authority (TDA). The Forward View sets out 'a new deal for general practice' recognising the central importance of the registered list and everyone having access to a family doctor. It also confirms the need for greater investment. In 2015/16, London will host a number of national ‘Vanguard’ sites – areas that will be prototyping the new models of service delivery set out in the Five Year Forward View. The vanguard sites will demonstrate new ways of organising general practice services and support the delivery of this Framework in London. 2. Better Health for London, The London Health Commission Also in October 2014, the London Health Commission published Better Health for London. The Framework closely aligns to, and is supportive of this report, which contained a number of recommendations specific to general practice. Foreword NHSE brochure 2015 FINAL_Layout 1 18/03/2015 16:21 Page 6 6 This Framework provides a response from the London Clinical Senate to review the commissioners across London to these important specification) and the CQC, for the aspirations we pieces of work. Between April and November wish to achieve. Additionally, the NHS Five Year 2014, over 1,500 key stakeholders were engaged Forward View and Better Health for London have as part of a pre-engagement.