Thoughts about the future of primary care and practical lessons regarding the implementation of change.

1. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Dr Robert Varnam
Director of General Practice Development
@robertvarnam
The future of primary care
and how to get there

2. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
What future for general practice?

3. @robertvarnam #GPforwardview
Pressure Opportunity

4. @robertvarnam #GPforwardview
UK general practice is one of the world’s most complete embodiments of the values of primary care
Personal Accessible personal care
built on a relationship from cradle to
grave
Community focussed Responsible for
a registered population, improving wellbeing
Holistic Dealing with the patient as a
person not a disease or part of the body
Comprehensive Handling wide range
of problems, managing clinical uncertainty
STRENGTHS OF PRIMARY CARE
“Primary” …
first, foremost,
central, key
Central Coordinating and connecting
other teams, referring where appropriate
Personal and population-orientated primary care is central …
if general practice fails, the whole NHS fails. Simon Stevens, General Practice Forward View

5. @robertvarnam #GPforwardview
Personal
Community focussed
Holistic
Comprehensive
STRENGTHS OF PRIMARY CARE
Central
Constraints on delivering
the full potential:
Demand >> workforce + funding
Practices are set up to provide mostly
medical care (reactive, individual >
proactive, population focused)
Hard to coordinate other inputs and ‘pull
in’ specialist support
Too small and isolated to have significant
impact on population or system
Primary care doesn’t need reinventing, but liberating to deliver its potential

6. @robertvarnam #GPforwardview
Specialists
Community
services
1948 CARE

7. @robertvarnam #GPforwardview
Self
Care
Broader skillmix
Self
management /
social
prescribing
Emergency
care
Collaboration
with specialists
At scale
FUTURE CARE

8. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
How are we going to get there?
One step at a time

9. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
How are we going to get there?
One step at a time Not just more of the same

10. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions
Innovations from around England
that release time for GPs to do
more of what only they can do.
bit.ly/gpcapacityforum

11. @robertvarnam #GPforwardview
Innovations from practices
throughout around England that
release time and improve care.
bit.ly/gpcapacityforum
GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions

12. @robertvarnam #GPforwardview
Innovations from practices
throughout around England that
release time and improve care.
bit.ly/gpcapacityforum
GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions
bit.ly/gpcapacityforum

13. @robertvarnam #GPforwardview

14. @robertvarnam #GPforwardview
Innovations from practices
throughout around England that
release time and improve care.
bit.ly/gpcapacityforum
GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions
bit.ly/gpcapacityforum

15. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
How are we going to get there?
One step at a time Not just more of the same
Function before form

16. @robertvarnam #GPforwardview
Working at scale: Opportunities for practices
Not automatic / magical
Some mergers achieve little
Some ‘alliances’ achieve much

17. @robertvarnam #GPforwardview
What size should we be?
 Personal focus
 Clarity
 Commitment
 Agility
 Population focus
 Alignment
 Priorities
 Partnerships
20 100
Don’t accept
either / or
solutions

18. @robertvarnam #GPforwardview
Sustainability and Transformation Partnership: 0.5-3m
System partnerships for large scale change
Workforce & infrastructure planning
Major partnerships & shifts in priority
Area network: 100-900k
Strategic partnerships
Organisational development infrastructure
Corporate support
Career development
Population wellbeing
Local network: 30-60k
Acute care
Shared MDT
Population management
Business functions
Team: 4-30k
Place of belonging
Doing the right thing at the right scale
Microteam: 2-500
Personal continuity of care

19. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
How are we going to get there?
 Pick something to achieve
 Do it together
 Build relationships & capabilities as you go
 Build structures & contracts to sustain new things
One step at a time Not just more of the same
Function before form

20. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Support available
 Rapid action learning collaboratives
 Intensive on-site support
 Coaching for leading improvement
Time for Care programme
One step at a time Not just more of the same
Function before form

21. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
General Practice Improvement Leaders Programme
Your Time for Care programme
Showcase
Action Programme
Do
Learn,
share &
plan
Do
Learn,
share &
plan
Do
Learn,
share &
plan
 Release time
 Improve care
 Build primary
care at scale
Preparation
Vision, narrative, strategic planning,
leadership development
Development Adviser Support
Consulting, coaching and connections for strategic leaders
QI fundamentals training
Primary Care Improvement Community
Productive General Practice
On-site Lean support for practices who want to go faster
6-12 month collaborative change programme for all practices
A tailored programme to create a movement for change, release time for care and build sustainable at-scale primary care.

22. @robertvarnam #GPforwardview
General Practice Improvement
Leaders programme
 Build capabilities and confidence to support
colleagues in implementing change in practices
Fundamentals
of change and
improvement
(2 days)
Human
Dimensions of
change
(2 days)
Facilitation
skills
(2 days)
National primary care improvement community
Your own change project

23. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Support available
One step at a time Not just more of the same
Function before form
Time for Care programme
youtu.be/FpJe62hfxTs