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New Models of Care, or Vanguard or MCP please see below

Date sent: Friday 3 July 2015

This email describes what is happening in one part of the Wessex LMC patch. I am involved in the development of the new structures and proposed change in services. I have been asked by many GPs to describe what this would mean for them and their patients. Change is going to happen and it will occur at pace.  So I hope this email will provide you with an insight into what may be possible.



What is changing in your local NHS?

By Dr Nigel Watson

Clinical lead for the SW New Forest 

In March of this year, the 7 local practices in the South West New Forest working in partnership with Southern Health (the local community provider) were chosen to be amongst 29 schemes nationally to test new ways of organising and delivering healthcare to local people.

The scheme aims to improve the accessibility and quality of out of hospital care by bringing together general practice, community care, specialists, social care and the voluntary sector into extended teams supporting the same local people.

The technical term for this is a "multi-speciality community provider" or MCP but we are simply calling it "Better, Local, Care" because that is what this is really all about.

It is part of a national drive to make the NHS better for patients and more sustainable for the future, as it is certainly creaking at the seams supporting an ageing population and growing demand with limited resources.

It is different because it is putting a lot of control in the hands of local clinicians, instead of trying to force top down change.  It is also about breaking down the barriers between organisations to work as one team who support the same patient.

We are working with two other local groups in Southern Hampshire, namely Gosport and East Hampshire.

In the rest of this newsletter you’ll find more about Better. Local. Care. and the difference it will make.  To succeed, we’ll need to listen to and involve the public and people who work in the NHS and the wider health system. So, over the coming weeks and months, we’ll be asking for your ideas, advice and involvement.   
To succeed, we need to continue listen and involve people who use services, work in the NHS and the wider health system. So, over the coming weeks and months, be involved. We are very open to your ideas, advice and guidance  If you have a special interest in any of the topics in this newsletter, please let know so we can involve you in the things that interest you in the future. 

In this issue, you can find out about:
  • The 7 Practices involved
  • The latest NHS jargon
  • The benefits for patients and GPs
  • Coming soon: What’s going to be different?
The seven practices involved in our MCP
  1. Arnewood Practice
  2. Barton & Webb-Peploe Surgery
  3. Chawton House Surgery
  4. Lyndhust Surgery
  5. New Forest Central Medical Group
  6. New Milton Health Centre
  7. Wisteria & Milford Surgery
Vanguards? MCPs?

A guide to the latest NHS Jargon
With any new scheme or initiative comes a barrage of new jargon, which you may come across when hearing about Better. Local. Care. Here is a glossary to help you navigate.

Five Year Forward View (FYFV or 5YFV)
The plan was written in 2014 by Simon Stevens, the CEO of the NHS, which sets out how the NHS needs to change to be effective and sustainable for the future.

New Models of Care (NMC) 
The new ways of organising and delivering healthcare, set out in the Five year Forward View and now being developed and tested in 29 sites across the country (including us locally). There are a range of care models because they need to reflect local circumstances rather than "one size fits all".

The name given  to the 29 sites where the new models of care are being piloted, so we are a Vanguard pilot site.

Multi-speciality Community provider (MCP)
This is one of the models of care set out in the FYFV and is what we are developing locally. It sees different health and care professionals, communities and voluntary groups working as one team to support the same local people, led by GPs.

Primary and Acute Systems (PACS)
Another type of care model, which is about integrating GP surgeries with acute hospitals (sometimes called vertical integration). There is a PACS model on the Isle of Wight and in North East Hampshire.
What are the benefits...
...for GPs?
  • We aim to create the opportunity to have a more varied week.
  • Creating new roles for younger and older GPs.
  • We want to make general practice the first choice for younger doctors
  • To add capacity to the existing workforce.
  • Evaluate the contributions that clinical pharmacists and extended scope practitioners could offer general practice.
  • More services embedded in the practice.
  • An integrated care team delivered at the level of the practice.
...for our patients?
  • More straightforward access to a wider range of health services via your GP practice.
  • Less need to go to an acute hospital for care.
  • New GP services being developed on the site of Lymington Hospital.
  • A wider range of healthcare professionals being available for patients.
  • More use of the voluntary sector.
  • Barriers between organisations removed.

Better. Local. Care. aims to make things more straightforward by bringing professionals together into one team supporting the same local people and to promote self-management and involvement of the voluntary sector.
How do we measure success?
To have any chance this must be real and meaningful to patients and those of us who work on the front line.

So the measures of success would include: a better patient experience; better clinical and social outcomes; greater job satisfaction amongst frontline staff; improved 
recruitment and retention; services that are better integrated and rated as good or excellent; reduced acute hospital admissions; reduced A/E attendances; better use of resources and care tailored to the needs of the local population.

A closer working relationship with the better sharing of information has got to be better for patients, GPs, practices, community and hospital staff.

We also need to be able to innovate and try new ideas without the fear of failure.
So what is going to be different?
Many of us have been around for some time and get mildly cynical when people talk of changes, especially in the NHS.  We therefore need to deliver change that is visible to our patients, the population we serve and the people that work in the NHS and other organisations to help and support people in their general health and wellbeing.

Some initiatives currently being developed:
  • Improved access to general practice
  • Use of technology to support and sign post patients
  • Closer working with the voluntary sector
  • Closer working between primary and secondary care
  • Increased support for the frail older person
  • Improved end of life care
  • Integration of general practice and community services
  • A new way of managing people with long term conditions
  • Improved children's services
  • The new world of Physiotherapy and Pharmacists
See below for more details about these initiatives.
Improved access to general practice
General practice has seen a significant rise in the workload over the last 5 years. Despite seeing over 1m people per day the capacity that practices offer does not always meet demand.  There is a national drive to provide general practice services from 8am to 8pm seven days a week. It would not be possible to deliver this at practice level.

What's happening?
The SW New Forest group of seven practices, working with New Forest Healthcare Ltd and Southern Health (the providers of community nursing and  Lymington Hospital) were successful in bidding for new resources to establish a new Primary Care Access Centre which will be an extension of each and every practice, providing services in a complementary way, integrated with practices. More details in the next issue.
Use of technology to support and signpost patients
In the UK we are one of the most advanced countries in terms of comprehensive electronic patient records but we lag behind other countries in the the application of technology to enhance healthcare in the community.

What's happening?
All seven practices are moving to a web based telephone system called VOIP, which will allow practices to work more closely together, supporting each other and integrating with the Primary Care Access Centre.

What's next?
We plan to test WebGP - a suite of online patient services developed by the Hurley Medical Group. The product gives patients access to advice and care via their own GP practice website, allowing patients to consult from home.

The services currently available to patients are:

  • Symptom checker
  • Self-help guides and videos about the most common conditions seen in general practice
  • Pharmacy advice
  • Links to the NHS111 service
  • E-consultations – patients can complete any of over a hundred condition-based questionnaires on their practice website, to request advice or treatment from their practice GPs. Practices will respond within one working day, offering a prescription, advice or to book an appointment.
A common electronic health record
Creating a strong out of hospital model of care, working at scale will need general practice and community services to work closely together. To create an integrated team that benefits from shared information and maximising the synergy and efficiencies that are needed, we are also exploring the creation of a shared record where practices and community services are able to jointly plan the provision of care and stop the duplication of work that is all too common currently.

Website and Intranet
Within the next month we hope to launch a website for our MCP that will contain information for GPs, Consultants, Community staff, etc., but will also have a public facing element to help and support our local population.
To help practices communicate internally, store, retrieve and share documents and much more, we are creating an Intranet in our MCP using Intradoc 247 - click here for more details.
Closer working with the voluntary sector

The voluntary sector have a wealth of knowledge about local needs and a tremendous amount of experience and expertise in tackling some of the most complex health and social issues facing our communities. For example, dementia care advisors have been employed by the Alzheimer's Society and work with patients, carers and general practice.  

What’s happening? 
We are challenging colleagues in health to think beyond a ‘medical model’ and are talking to Community First New Forest and others about developing new ways of working between health and the voluntary sector that maximise the benefits these organisations can offer our population.
Closer working between primary and secondary care

Locally we are very fortunate have the facilities and services that are offered by Lymington Hospital. We now have consultant medical cover 8am to 8pm seven days a week, and they are proving to be a valuable resource when GPs are considering admission.  Lymington also has state of the art diagnostics including Ultra sound, CT scan and MRI scan. 
Working closely with Dr Peter Hockey, the Medical Director at Lymington we are exploring new ways of working that better support general practice and our local population.
Using our Vanguard status we have the opportunity to "think outside the box". We have been told to be radical and double it.  
What's happening?
We are in the final stages of creating a database of GPs and Consultants, providing contact details available to all. This should help communication and provide much needed information. It will be stored is a secure area so that the information will not be available to the general public.

New Consultants? We now have 7 day consultant cover at Lymington Hospital. Three new consultants have been appointed recently.

Dr James Waller will undertake general medical duties and have  an interest in cardiology; we will work with the commissioners to ensure the new services meet the needs of our population. This could include a rapid access chest pain clinic, one stop Echo/ECG services and OPD assessments. We also need to consider new ways of working and other ways in which James can support GPs.

Dr Chris Roseveare - a past president of the Society of Acute Medicine, and a consultant from Southampton Hospital - will join us to support the 7 day consultant cover and also support the Gastro-enterology service and he will provide additional endoscopy sessions.
What's next? 
As services develop we want to offer opportunities that enhance career opportunities. One service that has recently been reprocessed is ENT, so we will shortly be looking for GPs who have an interest in ENT who would want to develop their skills and work in the new service.
Increased support for the frail older person

Living in such a beautiful part of the country attracts make this a very desirable retirement area.  The result is that we have a higher % of the population who are aged > 75.  Many are fit and well and live independently but we have a significant number who are not.
A recent concept that has been introduced to GPs is frailty, click here for more details. Those with advanced frailty are probably already known to GPs but those with mild frailty would benefit from social interventions such as improved diet and exercise. 
Those with moderate frailty are the group where the greatest benefit in terms of active intervention of health, social care and more structured support from the voluntary sector.
What's happening?
Dr Gill Turner, a local Consultant Community Geriatrician is an expert in this area and is working closely with the CCG, our locality and the MCP to develop services to help meet the growing needs of this population.
Improved end of life care

We are very lucky to have the services and dedication of those who work in our local hospice.  They offer in patient care, day hospital, hospice at home, palliative care nursing, chemotherapy administration as well as general advice.
End of life care could be improved locally if general practice, community services and Oakhaven were to work more as a single team rather than as separate services.
What's happening?
I am pleased that Oakhaven Hospice is keen to play a full role in the development of our MCP and in the provision of new and better services.

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Updated on 13 July 2015 2711 views