Frimley STP proposes radical upgrade of primary care

Proposals described in the Frimley Health sustainability and transformation plan would lead to the creation of 14 primary care “hubs” to be phased in by 2018.

Frimley Health FT is already in the process of establishing a primary and acute care system in north east Hampshire and Farnham. The latest proposals would extend the transformation of primary care into east Berkshire.

HSJ reported in September that Frimley was planning to extend its PACS model across the STP and develop a set of integrated primary care hubs. Although the final STP document details significant reforms to primary care, it stops short of proposing to extend the PACS.

The 14 hubs are likely to be based in Farnham, Fleet, Farnborough, Aldershot, Yateley, Surrey Heath, Bracknell and Ascot, the Royal Borough of Windsor and Maidenhead, and Slough.

The purpose of the GP hubs will be to create “single points of access” for social, mental and physical health care.

Physiotherapy will also be offered in general practice. This is expected to lead to a 20 per cent reduction in physiotherapy and secondary care referrals.

According to the proposals, total primary care expenditure will rise from £111m in 2016 to £136m, over 21 per cent by 2020-21 - a larger increase than either the acute or the mental health sectors. A further £8.5m will be spent on GP transformation.

There is currently no detail about the proposed governance model for running the GP hubs, but partners in the STP are meeting in December 2016 to discuss the governance model. A phased implementation plan will be agreed by February 2017.

More than £65m is projected to be saved over the next four years if the plan is successfully implemented. The majority of savings will be linked to five initiatives: self-care and prevention (expected savings: £4.8m by 2020-21); the creation of primary care hubs (£12.4m savings); general practice transformation (£7.1m); putting patients on “correct” care pathways (£36.5m) and social care transformation (£4.5m).

These savings are dependent on health providers making efficiency savings of three per cent per annum, which is “in line with historic levels of achievement”. Broader efficiencies from social care will deliver about £176m savings by 2020-21.

Critical to the success of the plan, the STP says, are two “enablers”: workforce changes and a shared electronic care record.

Workforce changes will include creating new roles such as health coaches, care navigators, clinical pharmacists and integrated mental health leads working alongside mental health clinical staff and general practitioners.

Ensuring that shared electronic care records are up and running will need added funding. The partnership is already planning to invest £30m of capital and £8m of revenue on technology, but a further £33m of capital and revenue needs to be invested between now and 2020-21 to make the Frimley system a “truly digitally enabled economy”, the STP says.

However the success of scheme depends on being extra investment. The STP states Frimley needs an extra £20m more than the announced funding of £47m from the sustainability and transformation fund.