www.england.nhs.uk

Primary Care

Networks:

Transforming care for local

communities

www.england.nhs.uk

Dr Tracey Vell MBE

Medical Director PC HinM

Assoc Lead in Primary and

Community Care GMHSCP

www.england.nhs.uk 3

Housekeeping

www.england.nhs.uk

Primary Care Forum

The Future of Primary Care Networks.

Sharing learning from the National ICS Primary Care

Development Programme

13th March 2019

Professor Nick Harding OBE

FRCGP FRCP SFFMLM HonMFPH DRCOG DOccMed PGDIP (Cardiology)

Senior Medical Advisor to Primary Care /Right care

Aston Medical School

Sandwell and West Birmingham CCG

www.england.nhs.uk

Simon Stevens, CEO, NHS England

If general practice

fails the NHS fails

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www.england.nhs.uk

www.england.nhs.uk

www.england.nhs.uk

My First Week

80%

Ian,

sick child

Christine,

diabetes

18% 2%

Stephen,

dementia

www.england.nhs.uk

Hand-Me-Down Healthcare

• We were using an outdated model

• 10 years later, we had twice as many patients

• The hand-me-down model was no longer

sustainable – something had to…

www.england.nhs.uk

Healthcare Fitted to Personal Need

Access point Training Focused Packaged

of Care

complex conditions become our challenge to deal with

www.england.nhs.uk 12

The changing health needs of the population are putting pressure on the health and social care

system in England.

The steady expansion of new treatments

gives rise to demand for an increasing range

of services.

New Treatments

And our expectations are changing too.

Things are changing…

Between 2017 and 2027, there will be 2

million more people aged over 75.

Ageing

population

The main task has changed from treating

individual episodes of illness, to helping

people manage long-term conditions.

Chronic

conditions

www.england.nhs.uk

General Practice Forward View lay foundations for change in general practice…

GPFV published in 2016:• Represented a turning point in investment in

general practice – committing an extra £2.4 billion a year to support general practice services by 2020/21

• Ambition to strengthen and redesign general practice

• Vision built on the potential for transformation in general practice:

• Enabling self care and direct access to other services

• Better use of the talents of the wider workforce

• Greater use of digital technology• Working at scale across practices to shape

capacity• Extended access to general practice

including evening and weekend appointments.

www.england.nhs.uk

Now continuing through the NHS Long Term Plan, placing primary care at the centre …

14

Aims:

• Everyone gets the best start in life

• World class care for major health problems

• Supporting people to age well

How:

• Primary care networks as the foundation for Integrated Care Systems

• Preventing ill health and tackling health inequalities

• Supporting the workforce

• Maximising opportunities presented by data and technology

• Continued focus on efficiency

www.england.nhs.uk

Do things differently, through a new service model1

Take more action on prevention and health inequalities2

Improve care quality and outcomes for major conditions3

Ensure that NHS staff get the backing that they need4

Make better use of data and digital technology5

Ensure we get the most out of taxpayers’ investment in the NHS6

Long Term Plan in summary…

www.england.nhs.uk

Currently there are 14 integrated

care systems (ICSs) across England

16

Integrated care systems (ICSs) have evolved

from sustainability and transformation

partnerships (STPs) and take the lead in planning

and commissioning care for their populations and

providing system leadership.

They bring together NHS providers and

commissioners and local authorities to work in

partnership in improving health and care in their

area.

NHS England ICSs, 2018

1. South Yorkshire and Bassetlaw

2. Frimley Health and Care

3. Dorset

4. Bedfordshire

5. Nottinghamshire

6. Lancashire and South Cumbria

7. Berkshire West

8. Buckinghamshire

9. Greater Manchester (devolution deal)

10. Surrey Heartlands (devolution deal)

11. Gloucestershire

12. West Yorkshire and Harrogate

13. Suffolk and North East Essex

14. North Cumbria

www.england.nhs.uk

• Build from what people know about their patients and their population .

• Put in place seamless care (for both physical and mental health) across primary care and NHS community services, and remove the historic separation of these parts of the NHS.

• Deliver care as close to home as possible, with networks and services based on natural geographies, population distribution and need rather than organisational boundaries.

• Integrate across primary care networks and secondary care/place-based care with more clinically-appropriate secondary care in primary care settings.

• Assess population health - focusing on prevention and anticipatory care - and maximise the difference we can make operating in partnership with other agencies

• Promote and support people to care for themselves wherever appropriate

• Because we want to make a tangible difference for patients and staff alike, with:

• improved outcomes for patients and an integrated care experience for patients;

• more sustainable and satisfying roles for staff, promoting development within multi-professional teams.

• a more balanced workload

Primary Care Networks –what are we trying to do?

www.england.nhs.uk

• Integrated care system •Alliance of commissioners and providers across health and social care

•Population based and outcomes focused within a shared budgetIntegrated care system

•Delivering efficiencies of scale and leadership support

•Providing a voice for integration across boundaries of careThe at-scale primary care

provider

•Geographically contiguous teams of practices caring for 30-50,000 people

•Delivery of data driven integrated multidisciplinary team based servicesThe primary care network

•Provision of resilient and sustainable core general practice

•Coordination and planning of holistic, personalised accessible careThe practice

•Supported by families and local communities

•Enabled and empowered to access care in a way which works for them The person

The Model of Care

www.england.nhs.uk

Individual

Neighbourhood

c.30k~50k

Place

c.250-500k

System

c.1+m

• Practices continue to provide core services

• Network Contract DES provides practices opportunity to work collaboratively with

other practices health, social care and voluntary partners to deliver services

• Practices and other health, social care and voluntary partners collaborate as

primary care networks, providing additional services that can’t be delivered on a

smaller scale

• Primary care interacts with hospitals, mental health trusts, local authorities

and community providers to plan and deliver integrated care

• In some systems, federations support efficiencies of scale and provide a voice for

primary care

• Primary care participates as an equal partner in decision making on strategy

and resource allocation

• Action is taken to ensure collaboration across hospitals, community services,

social care and other partners, helping to join up and improve care

• Data is used to deploy resources where they can have the maximum impact

• Primary care interacts with hospitals, mental health trusts, local authorities

and community providers to plan and deliver integrated care

• In some systems, federations support efficiencies of scale and provide a voice for

primary care

Primary Care networks – that’s all very well but what will they actually do?

www.england.nhs.uk

We think there are five main interconnected ‘building

blocks’ required to achieve the full / advanced state

(or Step 3) for primary care networks

Achieving

the

advanced

state

Vision

Care

model

JourneyEnablers

Support

www.england.nhs.uk

Plan: Plan in place

articulating clear vision and

steps to getting there,

including actions at

network, place and system

level.

Engagement: GPs, local

primary care leaders,

patients’ representatives,

and other stakeholders

believe in the vision and

the plan to get there.

Time: Primary care, in

particular general practice,

has the headroom to make

change.

Transformation resource:

There are people available

with the right skills to make

change happen, and a

clear financial commitment

to primary care

transformation. The

network is taking the

opportunities that GP

network contract affords

There is a clinical director

is for the network.

Practices identify PCN partners and develop shared plan for realisation. There is joint planning underway to improve integration with community services as networks mature

Analysis on variation in outcomes and resource use between practices is readily available and acted upon.

Basic population segmentation is in place, with understanding of needs of key groups, their needs and their resource use

Integrated teams which may not yet include social care are working in parts of the system. Plans are in place to develop MDT ways of working, including integrated rapid response community teams.

Standardised end state models of care defined for all population groups, with clear gap analysis and workforce plan

Steps taken to ensure operational efficiency of primary care delivery and support struggling practices.

Primary care has a seat at the table for system strategic decision-making.

PCNs are engaging directly with population groups, and with the wider community

Functioning interoperability within networks, including read/write access to records, sharing of some staff and estate.

All primary care clinicians can access information to guide decision making, including risk stratification to identify patients for proactive interventions, IT-enabled access to shared protocols, and real-time information on patient interactions with the system.

Early elements of new models of care in place for most population segments, with integrated teams throughout system, including social care, mental health, the voluntary sector and ready access to secondary care expertise. Routine peer review.

Networks have sight of resource use and impact on system performance, and can pilot new incentive schemes.

Primary care plays an active role in system tactical and operational decision-making, for example on UEC

Networks are developing an extensive culture of authentic patient partnerships

Fully interoperable IT, workforce and estates across networks, with sharing between networks as needed.

Systematic population health analysis allowing PCNs to understand in depth their populations’ needs and design interventions to meet them, acting as early as possible to keep people well.

Fully integrated teams throughout the system, comprising of the appropriate clinical and non-clinical skill mix. MDT working is high functioning and supported by technology. The MDT holds a single view of the patient. Care plans and coordination in place for all high risk patients.

New models of care in place for all population segments, across system. Evaluation of impact of early-implementers used to guide roll out.

PCNs take collective responsibility for available funding. Data is used in clinical interactions to make best use of resources.

Primary care providers full decision making member of ICS leadership, working in tandem with other partners to allocate resources and deliver care.

The PCN has built on existing community assetsto connect with the whole community.

Foundation Step 1 Step 2 Step 3

The journey of development for primary care networks in a health system – maturity

matrix

Our learning to date tells us that primary care networks will develop and mature at different rates. Laying the foundations for transformation is crucial before taking the steps towards a fully functioning primary care network. This journey might follow the maturity matrix below.

www.england.nhs.uk

People who were well recently but now need accessto care

Wh

at c

ou

ld c

are

loo

k lik

e o

n th

e g

rou

nd

?

Core characteristics▪ Digital front end (linked to NHS111) able to direct patients to self-care, pharmacists,

GP, physio or other most appropriate care first time, in person or remotely.

▪ Patients can access records and book appointments, where appropriate, online.

▪ Use of technology to promote wellness and encourage attendance and adherence to

medications.

▪ Joint working across networks to deliver access standard, with practices able to

cross cover.

▪ For urgent care, a GP or other professional acting as coordinator for a team of

clinicians, managing resources and matching to demand. Home visiting available

through paramedic, advanced nurse practitioner or other clinician.

▪ Clinicians can easily access secondary care advice, with named clinician in common

specialities.

▪ Seamless link to local out of hours services and urgent treatment centres with shared

care record.

▪ Use of data to identify groups who are not yet unwell but could benefit from

preventative medical or social intervention. Provision of information and support to

patients to help them to stay well.

Networks have:• Digital front end supporting effective navigation, signposting and advice for episodic

needs, and ability to book appointments online where appropriate.

• Primary care network urgent care model fully integrated with NHS111, out of hours,

urgent treatment centres and A&E, with shared care records.

• Patients being signposted to the most appropriate professional for their first contact.

• Access standards being delivered.

• Named secondary care clinicians for common specialities.

www.england.nhs.uk

People with stable long term conditions

Wh

at c

ou

ld c

are

loo

k lik

e o

n th

e g

rou

nd

?

Core characteristics

▪ Care delivered by a team of people including skills across GP, specialist

nursing, mental health, community and hospital specialists, interacting with

patients in person, remotely and virtually as appropriate. Hospital trainees

rotating through these roles. Most current outpatient services delivered in the

network.

▪ Continuity of care, with diarised reviews from the usual, named clinician and

relevant tests completed ahead of time.

▪ Digital front end, providing easy access to information for patients and

allowing repeat prescriptions to be ordered.

▪ Coaching and use of technology to support patients to self-manage and stay

well.

▪ Standardised treatment pathways, analysis of variation, and use of data to

identify patients at rising risk and for primary and secondary prevention.

▪ Social prescribing and group consultation in routine use.

Networks have:

• A mechanism to identify patients at rising risk and in need of preventative

intervention.

• Digital access allowing repeat prescriptions to be ordered and access to

information for self management.

• Ability to book diarised review appointments.

• MDTs demonstrating that they cover the skill groups listed.

• Patients able to access traditional outpatient services in the primary care

network.

www.england.nhs.uk

People with frailty and multiple long term conditions

Wh

at c

ou

ld c

are

loo

k lik

e o

n th

e g

rou

nd

?

Core characteristics

▪ Multidisciplinary teams (MDT) embedded within primary care networks or

hubs, with access to skills across GP, nursing, social care, mental health,

pharmacy, physios, occupational therapists and care coordination - addressing

physical, mental and social needs.

▪ Integrated frailty models between networks and secondary care to reduce

admissions, length of stay and delayed transfers of care (DTOCs).

▪ Risk stratification and case finding - with regular virtual, remote or in person

review depending on patient risk - enabling proactive intervention. Patients

regularly stepped up and down from MDT care dependent on need.

▪ Care planning reflecting patient preferences/choice, with proactive coaching to

support patient activation and self-management.

▪ Real-time interoperable shared care records used by MDTs who know their

patient cohort and each other by name.

▪ Rapid access home care (including for care home residents) provided by

MDTs.

Networks have:

• An integrated complex care/frailty model in place with established processes for

selecting patients.

• MDTs utilising and reviewing daily real-time data to intervene proactively to (a)

avoid deterioration and admission and (b) ensure rapid discharge.

• MDTs demonstrating that they cover the skill groups listed.

• Partnership working with the voluntary sector and social prescribing in routine

use.

www.england.nhs.uk

Core characteristics across all population cohorts

Wh

at c

ou

ld c

are

loo

k lik

e o

n th

e g

rou

nd

?

Core characteristics▪ Practices collaborating with other providers around natural local communities,

providing coordinated and anticipatory care.

▪ A business model for collaborative working and optimum use of collective resources

within and across networks.

▪ Integrated population health models for those with: episodic needs; rising risk; and

complex needs - informed by modelling through population health management

analysis.

▪ Redesigned, evidence based pathways across primary/secondary care, consultant

outreach and most outpatients delivered in the network.

▪ Focus on prevention, patient choice, and self care, connecting to a full range of

statutory and voluntary services.

▪ Data and technology to assess population health needs, support clinical decisions,

monitor performance and reduce variation.

▪ A workforce model that builds capacity and skills, gives greater resilience,

sustainable workloads and supports portfolio careers.

Networks have:• Established an agreed, shared, core care model for their local populations, with common

and standardised operating procedures.

• Real-time population health management data and analysis in place that is used by all

clinicians within the primary care networks and informs the focus of MDTs.

• MDTs meet the majority of local population health and care needs, with referrals outside the

network, and admissions minimised.

• A real time shared interoperable care record that is read/write across all providers.

• A shared view of resources and ability to shift resources to address population need.

www.england.nhs.uk

And in reality it’s already happening…….. andwe are learning from experience

Case study 1 : Thinking creatively about primary care in Luton

In Luton, practices are working together in groupings covering 30,000 - 70,000 patients, joining up different types of clinicians and bring together community services, social care, and mental health services around the practices to provide better care for patients.

Watch this case study at https://www.youtube.com/watch?v=YLntGo-BhPc

www.england.nhs.uk

Case study 2: How the NHS and social care are working with care homes across the Fylde Coast

Changing the way NHS and social care services work with care homes across Blackpool, Fylde and Wyre so that the system is less complicated for residents and staff.

Watch this case study at https://www.youtube.com/watch?v=LHdE6dVKKSk&feature=youtu.be

www.england.nhs.uk

Case study 3: Healthier Fleetwood Primary Care Home

Dr Mark Spencer talks about how the Healthier Fleetwood Primary Care Home is changing care for patients and communities in Fleetwood.

Watch this case study at https://youtu.be/MktOldZYpjU

www.england.nhs.uk

Primary care networks at the heart of the NHS Long Term Plan

29

Aims:

• Everyone gets the best start in life

• World class care for major health problems

• Supporting people to age well

How:

• Developing integrated care systems with primary care networks as the foundation

• Preventing ill health and tackling health inequalities

• Supporting the workforce

• Maximising opportunities presented by data and technology

• Continued focus on efficiency

www.england.nhs.uk

• PCN contract introduced from 1 July 2019 as a Directed Enhanced Service (DES).

• Will ensure general practice plays a leading role in every PCN and mean much closer working between networks and their Integrated Care System. This will be supported by a PCN Development Programme which will be centrally funded and locally delivered.

• By 2023/24, PCN contract is expected to invest £1.799 billion, or £1.47 million per typical network covering 50,000 people.

• includes funding for around 20,000 more health professionals including additional clinical pharmacists, physician associates, first contact physiotherapists, community paramedics and social prescribing link workers. Bigger teams of health professionals will work across PCNs, as part of community teams, providing tailored care for patients and will allow GPs to focus more on patients with complex needs.

• New shared savings scheme for PCNs so GPs benefit from their work to reduce avoidable A&E attendances, admissions and delayed discharge, and from reducing avoidable outpatient visits and over-medication through a pharmacy review.

• Extra access funding of £30 million a year will expand extended hours provision across PCNs and from 2019 see GP practices taking same-day bookings direct from NHS 111 when clinically appropriate.

How will the new GP contract support primary care networks?

www.england.nhs.uk

• Core general practice funding will increase by £978 million per year by 2023/24.

• New state backed indemnity scheme will start from April 2019 for all general practice staff including out-of-hours.

• Additional funding for IT which will allow both people and practices to benefit from the latest digital technologies.

• All patients will have the right to digital-first primary care, including web and video consultations by 2021. All practices will be offering repeat prescriptions electronically from April 2019 and patients will have digital access to their full records from 2020.

• A new primary care Fellowship Scheme will be introduced for newly qualifying nurses and GPs, as well as Training Hubs.

• Improvements to the Quality and Outcomes Framework (QOF) to bring in more clinically appropriate indicators such as diabetes, blood pressure control and cervical screening.

• Reviews of heart failure, asthma and mental health. In addition, introduction of quality improvement modules for prescribing safety and end of life care.

What are the other key elements of the contract?

www.england.nhs.uk

General Practice

General Practice

General Practice

General Practice

General Practice Care provided

across groups of

practices working

collaboratively

Social care

Clinical

PharmacyCommunity

mental health

Community

nursing

Community

therapies

Secondary

care

specialties

e.g. cardiology

Dementia

care

Frailty

Primary care network – what it might look like

With embedded services

operating from the group of

practices as part of the MDT

With wider services serving

the community reaching

into and providing care as

part of the network

A&E and

Urgent Care

Centres

Social

care

Wider VCS

services and

community

assets

Voluntary

sector

Care homes

Fire service

Drug and alcohol

services

First

responders

Dentistry

Ophthalmology

www.england.nhs.uk

Clinical Performance Dashboard

www.england.nhs.uk

Changing Face of NHS Leadership

www.england.nhs.uk

• Provides support for local communities, building on learning from the existing models;

• Provides advice on the key areas commissioners and practices might consider in establishing primary care networks locally;

• Sets out the vision for networks, core characteristics, care models at the heart of primary care at scale;

• Identifies key enablers that underpin effective development of networks.

A working definition

Primary care networks enable the provision of

proactive, accessible, coordinated and more

integrated primary and community care

improving outcomes for patients. They are likely to

be formed around natural communities based on

GP registered lists, often serving populations of

around 30,000 to 50,000. Networks will be small

enough to still provide the personal care valued by

both patients and GPs, but large enough to have

impact through deeper collaboration between

practices and others in the local health

(community and primary care) and social care

system. They will provide a platform for providers

of care being sustainable into the longer term.

Supporting the Development of Primary Care Networks

Programme of Support

• Communicating the vision – the benefits for patients and our teams.

• Supporting PCNs to mature – designing a programme of development following engagement over the autumn.

• Specific areas where doing once nationally will help – e.g. network dashboard, digital.

• BUT ULTIMATELY THIS MUST DEVELOP AND BE LED LOCALLY.

www.england.nhs.uk

What will be available to support PCNs

On establishment we have clear dates from the GP contract

WE WILL NEED TO SUPPORT LOCAL AREAS TO FOLLOW A TIMETABLE AHEAD OF JUNE 30 2019 TO ESTABLISH THEMSELVES

THIS WILL ENABLE PCNs TO TAKE THE FIRST STEP AND BENEFIT FROM THE NETWORK DES AND LAY THE FOUNDATION AS THEY (CONTINUE) TO MOVE WIDER THAN GROUPS OF PRACTICES WORKING TOGETHER TO WORK COLLECTIVELY WITH ALL THOSE WHO CARE FOR PATIENTS AND THE COMMUNITY

Date Action

Jan-Apr 2019 PCNs prepare to meet the Network Contract registration requirements

By 29 Mar 2019 NHS England and GPC England jointly issue the Network Agreement and 2019/20

Network Contract

By 15 May 2019 All Primary Care Networks submit registration information to their CCG

By 31 May 2019 CCGs confirm network coverage and approve variation to GMS, PMS and APMS

contracts

Early Jun NHS England and GPC England jointly work with CCGs and LMCs to resolve any

issues

30/6 Sign up by practice through CQRS

1 Jul 2019 Network Contract goes live across 100% of the country

Jul 2019-Mar 2020 National entitlements under the 2019/20 Network Contract start: year 1 of the

additional workforce reimbursement scheme; ongoing support funding for the Clinical

Director; Ongoing £1.50/head from CCG allocations

www.england.nhs.uk

• The PCN collaboration platform (FutureNHS) includes a range of slides and documents focused on PCNs and is available to join – please request access to the site by emailing england.PCN@nhs.net

• An ongoing series of webinars and events is helping to share best practice and advice. Full details at www.england.nhs.uk/pcn

• For any other queries, please email the team at england.PCN@nhs.net

Ways to Keep in Touch

• NHS England has developed an animation to help explain what a primary care network is. You can watch this animation and view details of forthcoming webinars and events at the following webpage: www.england.nhs.uk/pcn

www.england.nhs.uk

We will also have larger programmes of work in development

to support the short and the longer term

To be successful PCNs will need the time, space and support to develop and mature

We are developing a strong PCN development offer. We have: • Engaged extensively over the autumn/ winter • Learnt from ICS and reviewed the maturity matrix• Ensured continued dialogue with stakeholders and partners

We expect a comprehensive offer to be available from 2019/20 that will develop capacity to help create and sustain networks, both how the PCN works and what it delivers as a new workforcecollaborating together, as well as support to emerging leaders (regardless of profession)

We are working towards a framework of support that can be drawn down flexibly to support PCNs and responds to their development need as they mature and their plans for the future.

We want to support the specifics for PCNs, but to connect with the wider system development to ensure coherence

• Population Health Management and using data effectively• Working with communities• Workforce• Enablers – estates• Technical solutions – like indemnity

And some learning together, advice and help

www.england.nhs.uk 39

• In January 2019 NHS England and the BMA General Practitioners Committee in England published a five-year framework for GP Contract reform to implement The NHS Long Term Plan.

• The agreement sets out the changes in the 19/20 GMS Contract and joint proposals for reform for the four subsequent years.

• Specifically this agreement:

• addresses workload issues;

• brings a permanent solution to indemnity costs and coverage;

• improves the Quality and Outcomes Framework (QOF);

• introduces a new Network Contract DES;

• helps join-up urgent care services;

• enables practices and patients to benefit from digital technologies;

• delivers new services to achieve NHS Long Term Plan commitments;

• gives five-year funding clarity and certainty for practices; and

• tests future contract changes prior to introduction.

A Five Year Framework for the

GP Services Contract

www.england.nhs.uk

• In 2023/24, NHS England will make £891 million available which equates to £726,000 new annual funding for

a network with an average weighted 50,000 population.

• NHS England and GPC England are committed to making funding available for up to estimated 20,000+

additional staff in five groups by 2024.

• social prescribing link workers (reimbursement from 2019/20)

• clinical pharmacists (reimbursement from 2019/20)

• first contact physiotherapist (reimbursement from 2020/21)

• physician associates (reimbursement from 2020/21)

• first contact community paramedics (reimbursement from 2021/22).

• The scheme covers 70% of the actual ongoing salary costs of additional clinical pharmacists, physician

associates, first contact physiotherapist and first contact community paramedics. There is 100%

reimbursement of the cost for social prescribing link workers.

• Reimbursement for roles will be dependent on network size and skill-mix preference.

• In 19/20, every network of at least 30,000 population will be able to claim 70% funding as above for one

WTE clinical pharmacist and 100% funding for one WTE social prescribing link worker. Beyond 100,000

network size, this doubles to two WTE clinical pharmacists and two social prescribers; with a further WTE of

each, for every additional 50,000 population.

40

Addressing the workforce

shortfall – additional roles

reimbursement

www.england.nhs.uk

• The Network Contract will be a large Directed Enhanced Service (DES). By 2023/24, it is

expected to create national entitlements worth £1.799 billion, or £1.47 million for a typical

PCN covering 50,000 people, in return for phased and full implementation of all relevant NHS

Long Term Plan commitments. Of this, £1.235 billion is new investment.

• The Network Contract has three main parts:

• the national Network Service Specifications - these set out what all networks have to

deliver;

• the national schedule of Network Financial Entitlements, akin to the existing Statement

of Financial Entitlements for the practice contract; and

• the Supplementary Network Services. CCGs and Primary Care Networks may develop

local schemes, and add these as an agreed supplement to the Network Contract,

supported by additional local resources.

• GPC England and NHS England are committed to 100% geographical coverage of the

Network Contract by the Monday 1 July 2019 ‘go live’ date.

Introducing the

Network Contract DES (1)

www.england.nhs.uk

• Every practice will have the right to join a Primary Care Network (PCN) in its CCG and have a right to participate in the Network Contract DES.

• To be eligible for the Network Contract DES, a PCN needs to submit a completed registration form to its CCG no later than 15 May 2019, and have all member practices signed-up to the DES.

• CCGs are responsible for confirming that the registration requirements have been met by no later than Friday 31 May 2019.

• Once the registration requirements are met and GMS/PMS/APMS contracts have been varied to include the DES, the PCN can start receiving national investment from 1 July 2019.

• A typical practice can also receive over £14,000 each year from April 2019 as a new SFE payment, in return for their active participation in a PCN as demonstrated by signing up to the Network Contract DES.

• In the highly unlikely event that a practice doesn’t want to sign-up to the Network Contract, its patient list will nonetheless need to be added into one of its local Primary Care Networks.

• A PCN will typically serve a population of at least 30,000 people and must have a boundary that makes sense to: (a) its constituent practices; (b) to other community-based providers, who configure their teams accordingly; and (c) to its local community. Normally a practice will only join one network.

42

Introducing the

Network Contract DES (2)

www.england.nhs.uk

• All PCNs will have a Network Agreement, even those with one large practice. The Network Agreement is also the formal basis for working with other community-based organisations and must be signed by all constituent GP practices.

• A PCN must appoint a Clinical Director as its named, accountable leader, responsible for delivery.

• PCNs will also benefit from:

• 0.25 WTE Clinical Director support funding (per 50,000 population);

• a guaranteed £1.50 per registered patient from CCG allocations;

• many CCGs also provide support in kind for their PCNs e.g. through seconding and paying for staff to help with particular functions; and

• during 2019, NHS England will establish a significant new national development programme for PCNs.

43

Introducing the

Network Contract DES (3)

www.england.nhs.uk

Thank you

Email: england.pcn@nhs.net

Visit www.england.nhs.uk/pcn for more information

www.england.nhs.uk

Regional Update: Current position of PCNs,

challenges and next steps

Dr Tracey Vell MBE

Medical Director PC HinM

Assoc Lead in Primary and Community Care GMHSCP

www.england.nhs.uk

Regional Progress – PC Networks

2019/20 Planning Guidance: CCGs required to commit a recurrent £1.50/head to developing and maintaining primary care networks so that the target of 100% coverage is achieved as soon as possible and by

30 June 2019 at the latest.

North Region General Progress: • Latest January 2019 SDCS return (self reported) indicates performance across the

North Region is 88.8%. This is an increase of 17.4% since April 2018.

• As this is self-reported by practices, there may be some data quality issues.

• All DCO areas have a significant PCN development agenda and work programme.

• Some DCO Teams have had the ability to invest in PC Network development agenda over the past year.

• Mixed delivery models including Primary Care Homes, Neighbourhoods and Groups at various stages of maturity

www.england.nhs.uk

North region (SDCS data Jan. 2018)

*Greater Manchester data not available.

Region / STP % practices in a PCN

England 93.8%

North 88.8%

Cheshire & Merseyside 96.3%

Cumbria & North East 65%

Lancashire & South

Cumbria

98.2%

Humber, Coast & Vale 81.7%

South Yorkshire &

Bassetlaw

100%

West Yorkshire &

Harrogate

97.8%

0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00%

C&M

CNE

LSC

HCV

SYB

WYH

North Region PCN Progress

As at 31st January 2019(**) Note: 11 CCGs are missing from this report

Registered Population Registered Population (excluding CCGs that did not submit a return)

Number of practices Number of practices (excluding CCGs that did not submit a return)

Number of practices which are part of a network

% of practices which are part of a network

Number of Primary Care Networks currently existing within the CCG

EN 59,580,339 56,531,031 7,016 6,551 6,145 93.8% 1031

North 16,460,417 13,411,109 2,140 1,675 1,487 88.8% 272

Midlands and East 17,981,734 17,981,734 2,070 2,070 2,011 97.1% 318

London 10,010,236 10,010,236 1,282 1,282 1,189 92.7% 173

South West 5,817,060 5,817,060 602 602 553 91.9% 97

South East 9,310,892 9,310,892 922 922 905 98.2% 171

www.england.nhs.uk

Humber Coast and Vale progress

• 81.7% coverage

• 30PCNs in place

• Resilience funding has been used to support at scale projects further reinforcing the

need to work at scale across the region

• CCGS are working to procure services from GP practices at scale going forward rather

than on an individual practice basis

www.england.nhs.uk

South Yorkshire & Bassetlaw

progress• ICS; 100% coverage

• Single “journey of development” template mapping progress of each LCN through each of the 5 domains; Right Scale, Integrated working, targeting care, managing resources, Empowered Primary Care through steps 1 to 3.

• 36 networks in place across SYB

• Clear plans for investment of transformation resources provided by each CCG through 3 tranches.

• Primary Care System meetings underway bringing together all partner organisations with CCG and ICS Primary Care Programme leads – gives greater understanding of integration agenda and achievements.

• Wider Network events as part of the ICS Primary Care Programme have started with LCNs and then built on these with ‘workforce’, Population Health Mgt. January event brings these together with detailed analysis of each ‘journey’ including infrastructure and outputs against the matrix.

• Doncaster planning that GP Education sessions will go Multi disciplinary and include partner organisations from April 19 delivered in neighbourhoods

• In Rotherham, 1 locality is piloting MDT model for case management ( Community Nursing, social care, voluntary sector, mental health , hospice and primary care) roll out from February 2019

www.england.nhs.uk

West Yorkshire & Harrogate

progress• 97.8% coverage

• 46 networks in place covering 269 practices and 2.2m population

• Mixed models and variation in maturity

• ICS and NAPC accessed to provide support on development

• In Leeds Local Care Partnerships(LCP) have identified their own priorities linking to population health management. Four LCPs are focussing on frailty as part of the National population health management pilot

• Working groups established in those CCGs who do not currently have 100% coverage

www.england.nhs.uk

Risks and Issues

• Some practices are unwilling to be part of a network.

• Some practices do not fit naturally within networks ie safe haven practices

• Confusion over definitions, however some of the initial concerns (eg what constitutes a

network) have been clarified by the new GP contract and also that there is further

central guidance to come

• Lack of coordination in forming a network, both leadership and common goal

identification / agreement

www.england.nhs.uk

Next Steps

All practices to be part of a PCN by 30th June 2019• Registration form completed and submitted to CCG by 15th May 2019

• All member practices signed up for DES

CCGs to confirm registration requirements have been met by 31st May 2019

Provided registration requirements have been met and GMS/PMS and APMS contract variations have taken place, national investment can be received from 1st July 2019

PCNs start to develop through the maturity matrix

www.england.nhs.uk

How are Primary Care Networks making a difference to patients care

www.england.nhs.uk

What community pharmacies can

offer Primary Care Networks:

A case study from Greater Manchester

Aneet Kapoor, Chair of Greater Manchester Local Pharmaceutical Committee (GMLPC)

Fin Mc Caul, Greater Manchester Local Pharmaceutical Committee (GMLPC)

Steve Riley, Senior Primary Care Manager, Greater Manchester Health & Social Care Partnership

www.england.nhs.uk

About community pharmacy11,600 in England

700 in Gtr

Manchester

90% have private

consultation rooms

Pharmacies buck

the inverse care

law – more

pharmacies in most

deprived areas

Most accessible form of

healthcare:

• 90% of all health

contacts

• walk-in service in variety

of settings (e.g.

supermarkets)

• approachable staff

• 70% open Sat/Sun

• Many open 6am-

midnight (95 in Gtr Man)

Wide range of services &

expertise incl minor

ailments, long-term

conditions, health &

wellbeing, medication

www.england.nhs.uk

For example…

Pharmacy minor ailments

schemes save 1.4m GP

appointments a year (PSNC,

2017). This saves the NHS

£590m a year (PwC, 2016)

164k people were referred to

pharmacies for urgent

medicine supply in 2018 &

pharmacies dispensed 131k

urgent medicines (NHS England).

Pharmacies are 37 times

more cost-effective than out-

of-hours services (BMJ, 2016)

3.3m people had medicines

reviews & 920k people had

new medicine consultations

with a community pharmacist in

2017/18 (NHS BSA)

1m people had NHS flu

vaccinations in

pharmacies in 2017/18 (NHS BSA)

www.england.nhs.uk

PCNs & community pharmacy

• Opportunity for collaborative working to support patients

• ‘One team’ approach to patient care, long-term condition

management & population health

• Right care, right place – while avoiding duplication /

competition

• Collaborative approach to meet local community’s needs:

o What do we need to deliver?

o How do we make best use of everyone’s skills to deliver it?

• Requires shift in thinking & some enablers e.g. community

pharmacies serve whole population (not a registered list)

www.england.nhs.uk

Enablers

• NHSmail

• Summary Care Record

• Electronic Prescription Service (EPS)

• Electronic repeat dispensing (eRD)

• PharmOutcomes

• Increased data-sharing

www.england.nhs.uk

Community pharmacy commissioning

Core contract (national NHSE)

• Dispensing

• OTC / pharmacist-only medicines supply

• Health promotion

• Supporting self-care

• Signposting

• Queries & advice

• Disposing of unwanted medicines

Advanced services (national NHSE)

• Medicines Use Reviews

• New Medicine Service

• Seasonal flu vaccinations

• NUMSAS (urgent medicine supply) pilot

• NHS111 referrals pilot

Local services(examples)

• Minor Ailments Scheme

• Healthy Living Pharmacy

• Sexual health emergency pill

• Smoking cessation

• Health Checks

• BP / BG testing

• Needle exchange / supervised consumption

• Pilots e.g. Hep C, AF

www.england.nhs.uk

Opportunities in pharmacy

Urgent care

Pharmacies ideally placed to

support triage & alternative

channels e.g. minor ailments and

referral to pharmacy…

Digital Minor Illness Referral

Service (DMIRS) pilot

NHS111 and/or GP referral

straight to pharmacy

• 12-month GP referral pilot

in Radcliffe

Care navigation

GP practice staff signposting

appropriate patients to

pharmacy

• Live in Bury, Salford,

Stockport

Minor Ailments Schemes

Consultations &

advice/treatment in community

pharmacy

• 8 Gtr Man localities have a

MAS

www.england.nhs.uk

Opportunities in pharmacy

Health promotion & prevention

Pharmacies ideal setting for

public/popn health interventions

Screening/behaviour

change

Pharmacy staff specially

trained in health

conversations & advice

Healthy Living Pharmacy

scheme

• Now live in >90%

pharmacies

• Completed additional

training

• Commitment to improving

public health & wellbeing

Conversations & campaigns

High volume of conversations

on health campaigns e.g.

• Stoptober: 3,600 at 300 Gtr

Man pharmacies

• Bowel screening: 1,100 at

130 Gtr Man pharmacies

www.england.nhs.uk

Local services meeting local needs – from GM

ServiceGreater Manchester Inhaler Technique

Checks

• Many people use inhalers incorrectly -

exacerbation risk

• 60 pharmacies across Greater

Manchester

• Specially-trained pharmacists review

patient technique (InCheck & visual) and

help them use inhaler correctly

• Follow-up consultation to check progress

• GP communication / referrals

Consultation results:

• 51% using incorrect

technique at outset

• 93% using correct

technique after

review

www.england.nhs.uk

Local services meeting local needs

Bury ‘find & treat’: hypertension & AF

• Blood pressure tests in community

pharmacies for undiagnosed HT & AF

• Advice, structured support & referral (as

approp)

• Meeting local health need: prevalence

data suggests 16.7k undiagnosed HT &

834 AF

• Focusing on pharmacies because of

contact with ‘seemingly healthy’ people

• Stable long-term management in

pharmacies

www.england.nhs.uk

Long-term conditions

Pharmacy ‘health goals’ pilot

• One-year pilot for patients aged 18+ with at least

one LTC (e.g. hypertension, asthma, diabetes,

COPD)

• Consultation / conversation to co-produce health

goals, with up to three follow-ups roughly every

two months

• Measured outcomes: clinical, QOL, PAM,

MARS5,satisfaction etc

• Significant improvements & positive feedback

Outcomes

included:

• Improved

systolic BP

weight, BMI

and HDL

cholesterol

ratio

• More than 50%

improved PAM

• 94% PAM 1 at

baseline had

improved PAM

• 50% patient

goals achieved

www.england.nhs.uk

Engaging Gtr Manchester pharmacies

76

70

43

72

137

58

58+7

53

65

59

700pharmacie

s

2.8mpopulatio

n

10localities

56PCNs (neighbourhoo

ds)

www.england.nhs.uk

Context

• Mindset change from competition to

collaboration

• Hugely challenging pharmacy landscape

(funding, time pressures, drug shortages

etc)

• Increasing focus on direct patient care &

shared responsibility for outcomes

Workforce

transformation &

support required

for community

pharmacies

www.england.nhs.uk

Model: Evolving collaboration

General

Practice

Community

Pharmacy

TRADITIONAL WORKING COLLABORATIVE WORKING

ALLIANCE

BIG

IDEA

Combined Primary Care Teams

www.england.nhs.uk

How we plan to achieve this: Tameside pilot

• Bringing pharmacies together to work

with PCN & other providers in

neighbourhood

• Comms & training to explain what PCNs

are & why it’s important to get involved

• Visits & calls to all pharmacies, plus

ongoing support & training from named

LPC contacts

• Email forum for information-sharing

• Feedback & actions recorded

• Succession planning & sustainability

www.england.nhs.uk

Enablers & additional support

GM Healthcare Academy

• Partnership for workforce development &

training: pharmacy & wider primary care

• Focus on integrated working

Provider company

• CPGM Healthcare Ltd (CHL)

• All Gtr Man pharmacies are members

• Vehicle for contracting & performance

mgt

www.england.nhs.uk

Current Commissioning

Local authorities and CCGs can

commission local services from

community pharmacies. In Greater

Manchester, these include:

• Emergency Hormonal

Contraception

• Chlamydia screening, test & treat

• Smoking cessation, NRT and

Champix

• Needle exchange

• Supervised consumption

• Vitamin D supply

• Minor ailments

• Palliative care

• NHS Health Checks

The Local Commissioner:

Local Authority / CCG

Contract with EACH INDIVIDUAL

community pharmacy (up to to 144 in

some localities in GM) for EACH

INDIVIDUAL service. Local recording

mechanisms and training.

Pharmacies provide services under these

contracts, in turn often holding numerous

contracts with different commissioners for

various services that all differ across GM.

Patients experience unwarranted

variation in availability and delivery

www.england.nhs.uk

Current Commissioning The Local Commissioner:

Local Authority / CCG

Contract with EACH INDIVIDUAL

community pharmacy (up to to 144 in

some localities in GM) for EACH

INDIVIDUAL service. Local recording

mechanisms and training.

Pharmacies provide services under these

contracts, in turn often holding numerous

contracts with different commissioners for

various services that all differ.

Patients experience unwarranted

variation in availability and delivery

Sometimes services are commissioned

form a ‘lead provider’ that sub-contracts

to community pharmacies. Lead

providers may have little experience of

commissioning from pharmacies.

CCGs and local authorities now

use ‘lead provider’ models for

some services (e.g. substance

misuse)

Lead providers then sub-

contract some aspects to

community pharmacies (e.g.

needle exchange / supervised

consumption)

Patients still experience variation

in availability & delivery

www.england.nhs.uk

Proposed Commissioning Framework

Local commissioners commission via a

Single Commissioner representing the STP footprint

Single Commissioner contracts with a single

provider

Variation is minimised via harmonised service specifications that allow for

local variation, but maintain basic, standardised processes, training

requirements and IT reporting tools

Provider & Commissioner provide ONE IT platform with standard templates

for reporting activity and claiming payments

Provider contracts with community

pharmacies

Training and ongoing development delivered a central hub, e.g. Greater

Manchester Healthcare Academy. No need for local training

www.england.nhs.uk

Benefits of this model

• Resolves inequitable variations in availability & delivery – while

still enabling localisation to meet specific needs

• Potential for ‘tiering’ e.g. advanced inhaler service in areas of high

need

• Huge reduction in bureaucracy & administration associated with

local commissioning

• Provider can performance-manage

• Potential for outcomes-based commissioning

• Potential for capitation models for pharmacy management of long-

term conditions

www.england.nhs.uk

Summary

• Community pharmacies want to work with PCNs & have a vast

amount to offer (e.g. urgent care, earlier diagnosis, managing LTCs,

prevention)

• Services can be localised to meet specific health needs –

community pharmacies are ideally placed & easily accessible

• Increased focus on integrated working with GP practices, wider

primary care, other services (e.g. care homes, mental health, CVS)

• Community pharmacy workforce development crucial for

transformation

• Innovative commissioning models – e.g. via pharmacy ‘lead

providers’ – could enable outcome-based, performance-managed

services that have a real impact on people’s health & wellbeing

www.england.nhs.uk

Questions &

discussion

Contacts:

Greater Manchester LPC: enquiries@gmlpc.org.uk; 0161 228 6163

Aneet Kapoor: aneet.kapoor@nhs.net

Fin Mc Caul: fin.mccaul@nhs.net

Steve Riley: stephen.riley1@nhs.net

www.england.nhs.uk

HEALTHIER WIGAN

PARTNERSHIP General Practice

& the Neighbourhood Model

www.england.nhs.uk

General Practice In Wigan

The world as it was…

60 Surgeries

220 GPs 120 Nurses

Varying list size ( 1500 – 17000 patients)

Not working at scale

Not geographically aligned

3 Clinical Systems

Workforce/ morale

Clinical Variability

www.england.nhs.uk

Our vision for the Neighbourhood

Model

GP at the heart of an integrated health & care

system based on 30-50,000 population

Supporting resilient and high quality general

practice

Greater collaboration & joint working between

practices- scale & equity of provision

GP leadership in the SDFs- shaping health &

care provision with partners

Building teams around GP- primary, community &

acute as well as wider support

Patient centred care-holistic view & able to

address the wider determinants of health & wellbeing- connected to

communities

Proactive care and early intervention

Support for self care & self management- individuals supported to take control

www.england.nhs.uk

Working with our local

communities • One team approach

• 30-50,000 registered population

• Service Delivery Footprint Managers – convenors of place

• GP Clusters and joint working

• Leadership in each of the Cluster- GP, Practice Manager & Practice Nurse

• Integrated Community Services wrapped around GPs

• Multi-agency problem solving

• Co-location and agile working

• Alignment of schools

• Shared intelligence and SDF profiles

• Linked to Community Assets SDF multi-agency huddles

• Sub SDF neighbourhood teams in areas of greatest demand

• An asset based approach

www.england.nhs.uk

The key ingredients:

support tools & enablers

Strong & effective clinical leadership-Cluster meetings

Primary Care Standards

Business Intelligence – SDF profiles & data

packs

Renewing relationships with

partners & services e.g. community

nursing, mental health and consultants

Transformation Fund investment- capacity, workforce & voluntary sector partnerships

Community Link Workers & SDF

‘Huddles’ – access to wider support

networks

Management support-Assistant Director &

Business Transformation

Manager

HWP – facilitating joint working

IT, Estates, workforce development,

communications & engagement

www.england.nhs.uk

BUSINESS INTELLIGENCE BEING

USED TO DRIVE QUALITY &

MANAGE DEMAND

Some examples….

www.england.nhs.uk 82

www.england.nhs.uk 83

QIPP - Achieving our Triple Aim: better health

outcomes, quality care and lower costs of care

Circa £30m

www.england.nhs.uk#GPforwardview

10 High Impact Actions

www.england.nhs.uk

www.england.nhs.uk

Access

Equity

Safety

Outcomes

Productivity

Satisfaction

We asked the patients ahead of GP

collaborative what they want from

Primary care..

www.england.nhs.uk

10 High Impact Actions

www.england.nhs.uk

10 High Impact Actions

www.england.nhs.uk

Group Consultations

www.england.nhs.uk

10 High Impact Actions

www.england.nhs.uk

10 High Impact Actions

www.england.nhs.uk

Enhanced Training Practice

Hubs

• Won the Lead for GM

• Placed multidisciplinary workforce

• Growing our own

• Physician’s associates, Nursing students,

Paramedics, Allied Nurse Practitioners, Medical

Students, GP Trainees and Foundation year doctors

www.england.nhs.uk

EQUITY & SAFETY

Primary Care Standards (Reducing Variation, Driving Quality)

Quality and Outcomes Framework

Shared Processes/ Pathways of Care

Peer review/ Manager & Nurse Fora

Health Need rather than where you live

www.england.nhs.uk

10 High Impact Actions

www.england.nhs.uk

OUTCOMES & PRODUCTIVITY

Peer Reviews ( Referrals, Medicines, Pathways)

Value for money - avoid waste & duplication

Internal productivity – smart working

Workforce – Rear, Recruit, Retain and Return

Technology and Innovation

www.england.nhs.uk

10 High Impact Actions

www.england.nhs.uk

10 High Impact Actions

www.england.nhs.uk

10 High Impact Actions

www.england.nhs.uk

10 High Impact Actions

www.england.nhs.uk

10 High Impact Actions

www.england.nhs.uk

DEAL BEHAVIOURS

Our Part

WORKFORCE

Your Part

RESIDENT / COMMUNITY

BE POSITIVE AND ENGAGED

Give your best every day Trust we are ready to listen and change

Care about your work Care about your community

Believe in the borough Believe in the borough

BE OPEN TO DOING THINGS DIFFERENTLY

Be prepared to have a different conversation Be open minded to our new approach

Work with new technologies Tell us how technology can help

Know our communities better Tell us what works, what could be improved

Work with people, not do to or for people Be willing to work with us

Seek local solutions first Work with us to innovate locally

BE PERSONALLY RESPONSIBLE FOR RESULTS

Try to sort it out first time for people, solve it yourself

with people when you can

Tell us how to we can change the way we work with

you to build relationships and trust

Be clear why and when someone else takes

responsibility on

Understand we can’t always stay involved personally

and community often best lead

Raise it when the way we approach work gets in the

way of you being able to deliver results

Raise it when the way we approach work gets in the

way of you being able to deliver results

Make sure you tell someone if you’re worried, and

that you know what’s being done

Make sure you tell someone if you think people aren’t

safe

www.england.nhs.uk

The Deal for Care• Asset Based approaches

• Working with our

Community

• Changing the narrative

• Partners in Public Health

• Understanding our

footprint

www.england.nhs.uk

CARE HOMES MODEL

GROUP BASED CONSULTATION

Practice Collaboration

www.england.nhs.uk

Neighbourhood Model for Nursing &

Residential Homes

• Collaborative models for managing care home patients tested through business cases

• Evaluation of schemes and impact on unplanned admissions/ A&E attendances

• Development of specification

• Offered on GP Cluster basis as a Locally Commissioned Service

• Approach encourages practice collaboration, particularly in areas with high proportion of smaller practices

• Part of integrated offer including community nursing staff, pharmacists, OTs, dieticians and Consultant Geriatrician

www.england.nhs.uk

Partnership Working : Community

Link Workers & The Huddle

www.england.nhs.uk

PARTNERSHIP & SATISFACTION

Support Self care/ Prevention

Right Team for Right care

Avoid Duplication and Delays

Social Prescribing / Community Stroke

Action

Partnership working with Patients

www.england.nhs.uk

Bill’s Story- Integrating Care & Support

Repeated 999 call

outs & hospital

admissions

Frequent attender at

GP practice

COPD & Breathing

difficulties. Type 2 diabetic

Referred to Community Link

Worker via GP & acute

Living alone, recently bereaved,

mild learning disability, problems

with anxiety

Poor quality housing-

outdated heating

system. Financial

worries

New heating system

installed via AWARM.

Support from CAB

Adult Social Care

Assessment- carer

visiting twice a day

Joint work with COPD

Team & physio- breathing

exercises to manage

anxiety

Support to attend diabetes

self management course

Connected to local

community activities

GP referral to

Community Link Worker

& huddle

www.england.nhs.uk

Bill: Costed Case Study

2014 - 2015

Action Total Cost

£

A & E 28 5,824.00

COPD 16 3328.00

Admitted 39 67,080.00

Total 83 76,232.00

Ambulance 83 15,438.00

Grand Total 83 91,670.00

2016 - 2018

Action Total Cost

£

A & E 15 3120.00

COPD 10 2080.00

Admitted 7 12,040.00

Total 32 17,240.00

Ambulance 32 5952.00

Grand Total 32 23,192.00

www.england.nhs.uk

Enhanced Community Teams

Community Nursing Teams &

TherapistsMental Health support (5BP)

Voluntary & Community

Sector services

Start Well/ Children’s Services

Housing

Drugs & Alcohol services

Community Link

Workers

Social Workers/

Social Care Officers

www.england.nhs.uk

Jennifer.Gammack@wiganboroughccg.nhs

.uk

Senior Assistant Director – Primary

Care

www.england.nhs.uk

Thank you

www.england.nhs.uk

Thank You

www.england.nhs.uk

Table Discussion

www.england.nhs.uk

NHS England Maturity Matrix

www.england.nhs.uk

Questions

• Where are you in relation to the maturity matrix?

• What action need to take place and when to ensure all

practices in your area are in a PCN by 30th June

2019?

• Who needs to be involved?

• What are your next steps?

www.england.nhs.uk

FeedbackDr Tracey Vell MBE

Medical Director PC HinM

Assoc Lead in Primary and

Community Care GMHSCP

www.england.nhs.uk

CloseDr Tracey Vell MBE

Medical Director PC HinM

Assoc Lead in Primary and

Community Care GMHSCP