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CCG Profile: Dudley

CCG Profile: Dudley

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Although NHS England Dudley runs primary care services, Dudley clinical commissioning group recognises that supporting member practices is the key to success

Recognising the challenges faced by primary care nationally and across the borough, Dudley Clinical Commissioning Group (CCG) sees supporting our member GPs as a priority. 

The organisations primary care strategy has been developed following consultation with members and the public. 

It describes the organisations approach, which will build strong, high quality primary care providers who are as well placed as possible to meet new service challenges and deliver clinical priorities now and into the future. 

Dudley is one of the first CCGs to have developed and articulated the way in which the CCG can work to support and develop primary care. 

While the CCG does not commission primary care services, as that is NHS England’s territory, the focus of the strategy is on developing local primary care and supporting practices to provide high quality services for patients. 

Primary care is the cornerstone of local healthcare, and the CCG recognises that if we don’t tackle the challenges facing local practices, then it is unlikely that it will be able to deliver the improvements in health outcomes and health services it aims to achieve.

The strategy looks at increasing capacity in general practice and investment in primary and community care along with the development of integrated extended primary care teams using innovative solutions which the Health and Social Care Act offers us.

More than 90% of all patient contact with the health service happens in primary care. In addition, general practitioners are the key gatekeepers to hospital and other specialist healthcare services. 

Achieving the aims and priorities of the CCG’s wider strategic commissioning plans will in large part be dependent upon local practices being able to deliver improvements and participate fully in the prevention agenda.

 Ensuring stable, high quality, accessible primary care services is therefore essential to meeting the healthcare needs of our population.

As a clinically-led membership organisation, we are uniquely placed to deliver change and improvement in primary care. 

The aims of the strategy are:

 - To support local practices to maintain and improve the quality of primary care provision for patients.

 - To support the CCG commissioning strategy by contributing to reduce health inequalities, improving health outcomes, improving services and improving health and safety.

When developing the strategy, we found that many of the issues most regularly raised by patients, mirror those of local practices. Especially those focused on access issues which directly relate to practices’ concerns regarding the increasing pressures on their available capacity.

The challenges

We have the biggest change in the NHS since its inception, severe national economic constraints, an ageing population and increase in demand. During the last decade, general practice has become more robust in its governance and clinical practice, and is in a much better place to face the rigours of modern health care.

There are, however, further demands on primary care which are currently underway or which we will face in the coming years. Care Quality Commission registration, revalidation, GP workforce issues and changes to the GP contract will mean that we will have to contend with a more difficult working environment in the future.

In summary, there are a range of significant challenges facing primary care generally and GP practices in particular. These include:

 - Rising workload and pressure on access. Rising demand from patients within the context of limited and stretched capacity in primary care has been placing increasing pressure on practices. This is a major barrier to practices being able to maintain or improve quality standards and impedes their ability to support new care pathways.

 - Proposed changes to the national contract and other national initiatives will have a significant impact on general practice in a range of ways. The detail of the impact of the various changes on individual practices is difficult to calculate, but we know that most practices will need to make significant adaptations to their organisational arrangements to implement these changes successfully, meet required performance standards and maintain income. 

 - In addition to the concerns regarding the impact of these changes on workload and income, there are also concerns that this will be a negative impact on patient access, and recruitment and retention to general practice in the medium term.

 - A changing workforce and labour market point to the need for detailed and proactive succession planning as well as recruitment and training plans. For example, up to one quarter of Dudley GPs may retire within the next 10 years. 

 - Pressure on practice income due to cost inflation, static ‘pay settlements’ and increasing activity. 

 - Historic funding differences between practices and between GMS/PMS overall is a specific challenge within Dudley and there is a need to understand the impact of the proposed contract changes and develop strategies to manage the change smoothly, fairly and safely.

 - Increased transfer of work from secondary to primary care.

 - Pressure on premises which are too cramped and/or not of a sufficiently high standard for modern day primary care service provision.

 - Too much unwarranted variation in GP practice performance and the quality of service offered to patients.

 - Reduced organisational and management capacity at area team level due to the recent NHS reorganisation. 

The priorities and actions set out in our strategy enable the CCG and its members to meet these challenges. 

Priorities and solutions

Within the strategy, we have identified a number of priority areas which our members believe need to be tackled in order to enable them to provide high quality services for patients The full strategy can be found at www.dudleyccg.nhs.uk. Our next step is to work with members and the public to develop the support implementation plan. 

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