Dr Rebecca Rosen, Senior Fellow at the Nuffield Trust and General Practitioner in South East London, sets the context around the levers for change in general practice and primary care. Dr Rosen presented at the Nuffield Trust’s ‘Levers for change in general practice and primary care’ event on the 6th November 2014.

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Levers for change in general practice and primary care: setting the context
Dr Rebecca Rosen
Senior Fellow
The Nuffield Trust
General Practitioner
South East London
November 6th 2014
13/11/2013

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Overview
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What changes are we trying to achieve?
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Brief overview of recent levers for change
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Aims of the workshop

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Hardly a week goes by….

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London commissioning framework for primary care transformation
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Accessible care
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Extended hours
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Underpinned by technology
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Adapted to the needs and preferences of different patient
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Proactive care
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Supporting health and wellbeing
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Building capacity for self care
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Developing community resilience
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Coordinated care
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Continuity for complexity
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Care planning and multidisciplinary working for selected patients
What are we trying to achieve?...

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What are we trying to achieve?...
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Large scale primary care organisations
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Various forms emerging (super practices, networks, federations, multisite providers)
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Broadening scope of services offered
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Infrastructure for economies of scale and quality improvement
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Focus for integrated provision
Super-practices
Networks
Multi-site operators
Federations

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Recasting the relationship between patients and clinicians
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Access to a senior clinician as early as possible in any contact with the practice.
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Access to primary care advice and support underpinned by systematic use of technology.
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Patients have minimum number of separate visits/consultations.
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Patients offered continuity where this is important, and access at the right time when required
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Care is proactive and population-based where possible, especially for long-term conditions
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Care for frail people with multi-morbidity is patient-centred/tailored to individual need
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GPs work as part of a multi-disciplinary team within and beyond the practice
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Where possible, patients are supported to identify their own goals / manage their own condition and care
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Organisational change in GP practices: access to diagnostics, integrated electronic records For further detail see Securing the Future of General Practice. Nuffield Trust 2013
Underpinned by new ‘design principles’

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Similar changes/challenges in other professional sectors
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Reorganisation into chains
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Standardisation of professional practice
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More measurement and transparency
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Recasting professional standards and ethics (banking)

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Transforming the nature and role of general practice
Changes in scale and content of GP work Recasting relationships between general practice and other services Extending GP roles in integrated care pathways and community based care
But also: ‘Preserving the art of general practice’ Balancing patient relationship with measurement and reporting Re-professionalisation and higher trust ?

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Brief overview of recent levers for change
Financial micro-incentives:
•Quality and Outcomes Framework
•Local enhanced services / commissioning incentive schemes Contracts and contracting:
•Contracts for GPSI and integrated services
•Practice based commissioning – changed referrals, prescribing Peer learning and influence:
•Review by peers of clinical performance data and other areas of clinical practice
•National collaboratives Redesign of organisational culture/re-professionalisation:
•Peer led change
•Strengthening sense of professionalism and accountability for good outcomes Structure and process (barriers)
•Referral management centers etc

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Financial micro-incentives as the dominant paradigm ?
Multiple financial micro-incentives:
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QOF targets
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PMS contract KPIs
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Local contract KPIs
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National enhanced services
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Local commissioning incentives schemes

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Aim of today’s workshop
To examine the range of methods currently used to change and improve general practice and primary care and to consider which method or combination of methods is most likely to deliver sustainable, transformational change; better outcomes and better patient experience of care.

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How do you change GP behaviour?
•Better patient outcomes
•Better working day
•Better income
•Peer recognition Dr Larry Casalino