Healthy London Partnership has launched Next Steps to the Strategic Commissioning Framework – a vision for strengthening general practice. The framework provides guidance and resources that will support practices to develop high quality larger-scale general practice collaboration across London.

Developed in partnership with London Clinical Commissioning Groups, London wide Local Medical Committees (LMCs) and overseen by the Primary Care Clinical Cabinet, the framework aims to support practices across the capital to identify, create and build collaborative arrangements that work best for their local circumstances. It brings together learning from across London and shares flexible models for developing ways of working together that can be adapted to meet their needs to deliver primary care transformation.

Helping practices address the changing needs of patients

The framework recognises that practices across London are at different stages of collaboration and shares guidance on how to start, build upon or enhance collaboration locally. It aims to help practices address the complex issues around the changing needs of patients, both in the complexity of their conditions and in their expectations.

The new guidance builds on ‘Transforming Primary Care in London: A Strategic Commissioning Framework’, which set out a new vision for delivering primary care in London in 2015. ‘Next Steps’ describes how deeper and wider collaboration between practices is the key to achieving person-centred primary care through either larger scale general practice models (LGPOs) or Primary Care Networks (PCNs).

Almost every London practice is now part of a larger-scale general practice organisation, providing the foundations for new Integrated Care Systems (ICSs) across London that will bridge the traditional boundary between provider and commissioner.

Dr Michelle Drage, Chief Executive, the Londonwide LMCs said:

 “As demand for general practice services continues to increase and grow in complexity, putting great pressure on the people working within it and stretching the resources at their disposal, practices of all sizes need support to adapt and transform to meet this challenge, while retaining the values of general practice.

 “This document considers how practices can collaborate and develop ways of working together which are the right fit for them, while acknowledging that there is no single approach which works for every set of circumstances.

 “Many of the biggest innovations in the 70 year history of the NHS have come from within GP surgeries. Given the right tools London general practice can continue to meet the needs of patients, while managing the challenges of the modern NHS.”

Dr Jonty Heaversedge, Medical Director for Primary Care and Digital Transformation (London Region) said:

‘’The Next Steps for general practices in London describes an essential ambition to improve patient care whilst ensuring a sustainable future for general practice at the heart of new models of integrated care in London.  We have already seen how working together at greater scale is making a difference and enabled us to provide access to high-quality care in the evenings and at weekends for every Londoner. We recognise the opportunity to build on this, working with other community services and using digital technology to transform the way care is delivered in Primary Care Networks. Central to this vision is the need to protect the core values of general practice and ensure that patients who need it can access on-going, whole-person care with their local practice team – ensuring that we are able to be both big and small at the same time.

 ‘’Working collaboratively at scale will be key to securing a sustainable future for general practice, providing personalised continuous care for those who need it, at the same time as reducing waste and sharing new opportunities to better understand our local population and deliver care that is more coordinated and proactive – helping people to stay healthy for longer.

‘’London is one of the most populous and diverse cities in the world; we want London to be the healthiest city in the world, and to achieve this we must secure the sustainability of general practice now and in future. The Next Steps for general practices in London aims to support practices to develop the skills and expertise they need for a vibrant future at the heart of new models of integrated care.

 ‘’The Next Steps for general practices in London shows that by working together at larger- scale, we can continue providing patients with personalised, whole-person care at practice and network level. The framework also provides strategic support to strengthen leadership within larger-scale general practice organisations; giving practices a greater collective voice whilst benefiting from shared experiences, resources and skills.

Professor Sir Sam Everington, Chair of the London Clinical Commissioning Council, said:

“With the support of all five Sustainability and Transformation Partnerships and our regional clinical cabinet for primary care, we are setting out a clear, achievable vision for how general practice organisations can work collaboratively at scale. We must continue to learn from best practice as we proceed, building on existing evidence, using emerging evidence on new models of care, and making sure that the value and values of general practice are not lost in the process.

The Next Steps for general practices in London brings together learning from across London, the country, and the rest of the world. It will take forward at scale working in a way that is true to the values of general practice, as the NHS realises its vision of Integrated Care Systems nationally. In so doing, we are confident that we will protect and enhance this cornerstone of care provision in London.”

Collaborative arrangements in London

The framework outlines two main types of collaborative arrangements between practices. These are:

• Larger scale general practice models (LGPOs) where multiple practices work via formal collaborative arrangements enabling them to develop and train a broad workforce, create shared operational systems and quality improvement approaches.
• Primary Care Networks (PCNs) where practices come together with community providers and the voluntary sector to serve smaller populations. The vision is for the creation of multi-disciplinary, team based care for those with enduring, complex health and care needs.

Benefits to large-scale working

Current workforce is under increasing pressure and GPs are facing a growing workload as a large proportion of GPs in the capital are nearing retirement age and practice nurses are becoming increasingly difficult to recruit. The new publication cites local examples and evidence that large-scale general practice is delivering significant positive results across London to tackle these issues. Benefits to large-scale working include:

• A developed workforce – new training, support systems and roles for current team members, and new specialists, such as clinical pharmacists, joining the workforce.
• System partnerships – built by an empowered workforce that speaks with a collective voice, and that integrates its work within the rest of the system.
• Economies of scale – efficient creation of policies and procedures, combined purchasing power, and more.
• Better care and new services – like extended access.
• Better quality improvement – thanks to collaboration among the members of a Primary Care Network or other team.
• Greater resilience – by sharing back-office functions, pooling team members and developing business intelligence systems

Guidance, templates and resources are available on the Healthy London Partnership Transforming Primary Care website. You can also email the HLP Transforming Primary Care team to find out more: england.londonprimarycaretransformation@nhs.net.

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