Jack Smith, Transformation Consultant and Health Psychologist at the NHS Transformation Unit (TU), talks us through the critical support provided by the TU to Primary Care 24 (PC24) in Merseyside, developing a creative yet credible plan to establish a resilient, multi-disciplinary workforce necessary to deliver a financially viable and high-quality primary care service offer.
Until recently the TU has worked primarily within the acute care setting. However, having worked with PC24, we were pleased to utilise our skills and expertise garnered through years of successfully delivering acute change to support the design and implementation of new models of primary care.
PC24 is a social enterprise, delivering a range of primary and urgent care services to just under one million people across Halton, Knowsley, Liverpool, St Helens and South Sefton in Merseyside.
In 2017, PC24 acquired responsibility for the delivery of primary care services at seven GP practices in Sefton serving approximately 20,000 registered patients. These services are delivered by GPs, nurses and other clinical and administrative staff that are employed (or contracted) by PC24 under Alternative Provider Medical Services (APMS) contracts, which were awarded following a successful tender process in Summer 2017.
All seven practices are significantly challenged in terms of financial sustainability and with salaried workforce recruitment and retention issues – not unlike many individual practices across the country as highlighted in the NHS Long Term Plan.
As a Health Psychologist I had previously worked as a shared clinical resource across a portfolio of GP practices in Wirral, Merseyside. I was part of a multi-disciplinary team providing targeted interventions for patients with long-term conditions and comorbid mental health needs to improve self-management and reduce unplanned A&E attendances. I had genuinely witnessed first-hand the positive impact that a multi-disciplinary team model can have on patient outcomes, staff satisfaction and reducing unnecessary health system costs.
Working closely with PC24 clinical and non-clinical staff and drawing upon best-practice and lessons learned from elsewhere, the TU led the Phase 1 delivery of a comprehensive Strategic Outline Case for presentation to their Commissioners in early 2019 including:
- Evidence based case for change.
- A proposed linked model for the seven practices that makes best use of available resources and digital technologies whilst maintaining a local community focus.
- Description of a new multi-disciplinary staffing model that maximises GP time for complex patients and utilises shared resources across the practices such as pharmacy, physiotherapy, paramedics, social prescribing and mental health.
- Workforce plans to attract and retain primary care health professionals in partnership with world-class academic and research institutions in Merseyside.
- Indicative income and expenditure profile highlighting phased reductions in expenditure towards closing the financial gap.
- Phased transformation plan with associated resource costs over the next three years.
The TU continues to work closely with PC24 in 2019 to deliver phase 2 of the programme through the provision of experienced programme management leadership, helping to drive the necessary changes outlined in a systematic and quality assured way.
“Without the TU, we would simply not have been able to produce a costed, credible and robust plan to present to our commissioners in the short time we had. They understood our requirements and quickly produced an excellent piece of work which did not compromise on quality,’”- Dr Mary Ryan, Chief Executive, Primary Care 24.
Larger scale models of primary care are clearly signposted as the direction of travel in the NHS Long Term Plan – we believe the TU has the skills and expertise to support the design and implementation of new primary care models.
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