Annual Review

Foreword

Welcome to Greater Manchester Primary Care Provider Board’s (PCB) annual review for 2022/23.

It’s been a busy and significant year for us, so we wanted to take the opportunity to reflect on our achievements and share some of the key successes which have contributed to the Greater Manchester Integrated Care Partnership (GMICP) and enabled us to raise our profile and develop our work to support primary care providers in Greater Manchester. 

Dharmesh Patel, Chair

Dr Tracey Vell, Chief Officer

Who we are, what we do and why

The PCB is centred around one shared vision of: Primary care providers working collaboratively and in partnership at neighbourhood, place and system level to improve health and wellbeing throughout our communities.

Established in 2015, we are England’s first primary care collaborative. We give Greater Manchester’s 1,800 primary care provider organisations (across community pharmacy, dentistry, general practice and optometry) a single voice.

PCB Delivery Team

We have established a Delivery Team to manage our programmes of work. The team brings together programme management disciplines, quality improvement, change management, clinical and provider leadership into a single function. This subject matter expertise is underpinned by large-scale change methodologies.

The team works alongside and has strong relationships with key system improvement partners, including Health Innovation Manchester, Strategic Clinical Networks (SCN), the Clinical Research Network (CRN) and Aqua, as well as thought leaders in the area of primary care development, including the NHS Confederation and the Royal College of GPs.

Through these networks and the connections formed by the PCB, the Delivery Team has a strong reach across primary care and can respond to current thinking and be relevant to primary care today.

In addition, the Delivery Team supports Greater Manchester locality teams, making sure there are links across localities and mutual support is available, along with a culture of continuous improvement and development.

We also take commissions to deliver against specific priorities.

Fundamentally, the PCB, supported by the PCB Delivery Team, provides multiple functions, enabling the board to:

• Develop strategy and a strong voice for primary care within GMICP, regionally and nationally.
• Deliver quality improvement across primary care providers, transforming care, reducing variation and improving patient experience and outcomes through a number of Greater Manchester, local or neighbourhood-led programmes.

We do this by:

• Championing and driving innovation, quality improvement and transformation.
• Promoting and supporting exemplar employment practice, support, development and wellbeing for our 22,000-strong workforce through our HR function.
• Creating and developing a sharp communications function, brand and consistent identity for the PCB.
• Providing a sophisticated analytics and business intelligence function for the PCB.
• Supporting and engaging clinical leadership in quality improvement and subject matter expertise.

Our governance

Our provider board infrastructure was set up seven years ago, as part of the opportunities presented through Greater Manchester’s devolution deal. During 2022/23, we have been adapting to the new Integrated Care System infrastructure and have begun a review of governance which will continue into next year, to align with GMICP. This will see changes to all the discipline boards during 2023/24, including changes to structure and chairs within the General Practice Board. The PCB will be reviewing membership to come into place in early 2023/24.

We have a presence on NHS Greater Manchester Integrated Care Board (NHS GM) to represent Greater Manchester primary care providers. Dr Vish Mehra was successfully elected from the PCB to sit on the unitary board, providing primary care provider insight into NHS GM, and reporting back to the PCB.

The PCB is a formal part of GMICP governance, with members of the PCB and its four discipline sub-boards representing primary care on numerous system boards, committees and subgroups.

Dharmesh Patel chairs the PCB and we have four discipline provider boards. During 2022/23, these were chaired by Luvjit Kandula (community pharmacy), Don McGrath (dentistry), Dr Tracey Vell (general practice) and Dharmesh Patel (optometry). The chairs plus three members of each discipline board sit on the PCB, alongside representatives from nursing and an NHS GM primary care representative. The board is supported by the PCB Chief Officer, Managing Director, Programme Director, and Board Secretariat. The board meets monthly, on a minimum of 10 occasions a year.

During 2022/23, the PCB has established dedicated system committees for elective and urgent care. These committees feed into the Greater Manchester wider system boards for their areas of work. They represent a place where primary care issues can be discussed, with a commitment from members to engage and discuss widely with colleagues so we can establish agreement on changes to care pathways with appropriate primary care input. It is our ambition to extend these groups to other areas, as well as to develop delivery arms with appropriate funding. 

Our 2022/23 key achievements

Telling a consistent story

This year, we engaged our board to develop a shared vision and strategic narrative. These are now at the heart of how we present ourselves to our providers and to the wider Greater Manchester health and care system. They will support us to tell our story in a clear and consistent way to all our stakeholders.

In October 2022, we launched our website www.gmpcb.org.uk. The site aims to be a one-stop-shop for our 22,000-strong Greater Manchester primary care workforce, providing information, resources and signposting to support providers’ ongoing quality improvement journey.

It brings together information and resources which previously sat on multiple separate sites, including GP Excellence, health and wellbeing and dentistry content. Structured around the four primary care disciplines, busy providers are directed to relevant content quickly and easily.

Since launch, the site is averaging around 1,500 users and 4,000 page views each month. We aim to improve interaction and engagement with the site as it becomes embedded in our business as usual way of working for primary care users.

In February 2023, we launched our visual identity. As an NHS collaborative, the PCB has an official NHS logo, which is its primary identifier. To further strengthen the PCB’s identity and recognition in a system with multiple NHS organisations, a visual identity was developed in line with NHS Identity guidelines. This ensures consistency across all PCB documents and materials.

Our funding flows

Our work to establish financial flows for primary care was a significant part of the PCB contribution to the developing GMICP. We are now seeing this come to fruition as the GMICP new ways of working are established and funding is starting to flow directly to primary care providers. Our ambition has been for primary care providers to be able to bring transformation funding to the table in their locality and codesign plans that improve health and wellbeing throughout our communities.

Primary care summit

In September, more than 350 primary care professionals came together to share ideas, successes and solutions at the Greater Manchester Primary Care Summit.

Jointly hosted by the PCB and NHS Greater Manchester Integrated Care, the event provided an opportunity for attendees to help shape the future of primary care as well as network with colleagues working at every level in primary care.

Representatives from all four primary care disciplines explored the current challenges facing primary care, shared quality improvement ideas and best practice approaches through a variety of interactive workshops, spotlight sessions and a busy marketplace, finishing with an expert panel discussion.

Ideas, issues and themes from the day helped shape the content, structure and inform development of a blueprint for the future of primary care in Greater Manchester, due to be launched in 2023.

The blueprint work is being led jointly between the PCB and NHS GM Primary Care Team. 

Community pharmacy

A focus for the Community Pharmacy Provider Board during 2022/23 has been to support providers with the pressures relating to finance, workforce and increased workload. 

Other key activity has included:

• Launched the first Pharmacy Excellence programme in September 2022 to support pharmacies by providing tools and support to improve operational efficiency to maximise the existing resource and capacity to reduce pressures through redesign of existing dispensary operational models.
• 97 per cent deployment of GP Community Pharmacy Consultation Service across practices and community pharmacies, with a total of 45,000 referrals completed successfully to date.
• More than 400 providers engaged and trained to deliver a hypertension case finding service to support prevention of cardiovascular disease. This includes development of a GP/pharmacy integrated pathway and IT referral system.
• Continued delivery of NHS 111 Community Pharmacy Consultation Service and Urgent and Emergency Care NHS 111 pilot to support the NHS and patients.  
• Ongoing work to deploy the Smoking Cessation Advanced Service in trusts and community pharmacy to support prevention and Core20PLUS5 targets.
• Delivery of more than 800,000 Covid-19 vaccinations through community pharmacies to date.
• Supporting pharmacy contractors with safety and security monies.
• Working with GMICP leads to address issues with antibiotic supply and wider stock and supply issues, as well as highlighting the significant challenges faced by the community pharmacy sector to maintain open doors and accessible care to patients.
• Begun work to enable the rollout of the Greater Manchester Care Record across all community pharmacies.
• Continuing to fund Healthy Living Pharmacy leadership and champion training places to support pharmacy staff to achieve Royal Society of Public Health qualifications to support prevention and Healthy Living Pharmacy accreditation.
• The Community Pharmacy Provider Board has also secured IT funding for PharmOutcomes to support integrated referral systems between GPs, trusts and community pharmacies to support seamless integration.
• Further planning is taking place to support imminent rollout of the Pharmacy Patient Group Directive (PGD) contraception service.
• We continue to achieve above national average delivery of the Pharmacy Quality Scheme, with more than 92 per cent of Greater Manchester contractors participating in 2021/22 (latest data).

Dentistry

The Dental Provider Board is proactive in promoting the maintenance and development of NHS dental services in Greater Manchester. A focus for the board during 2022/23 has been to support providers with pressures relating to finance, workforce and increased workload.

Key activity has included:

• Improving patient access and developing a quality premium scheme – it is well recognised that 2022/23 was an extremely challenging year for NHS dentistry in Greater Manchester. The Dental Provider Board and Greater Manchester Local Dental Committees (LDCs), in collaboration with GMICP, have worked together to develop an innovative scheme for 2023/24. Practices have been offered a quality premium payment of six per cent of their total contract value. In return, they will provide access to urgent and new patients at a level that is proportionate to the size of their whole contract value. The quality scheme provides much-needed financial support for general dental service practices and aims to improve access for NHS patients. The Dental Provider Board believes this is the most innovative new way of working in NHS dentistry for nearly 20 years. This scheme illustrates what commissioners, providers and partners can achieve by working together to find solutions to address local health needs.
• Addressing health inequalities – the Greater Manchester Access Plus Scheme was successfully rolled out in 2022. The scheme aims to improve access and deliver continuation of care to patients who have received urgent care, but who require further care and treatment within an NHS dental practice.
• Delivering quality assured initiatives – the Healthy Living Dentistry (HLD) project continued to develop over the last 12 months. There are 60 practices across Greater Manchester involved. Dental practices undertake national and local health campaigns, often linked to local GPs and community pharmacies. Plans are in place to begin a further recruitment campaign to encourage all practices to sign up to this scheme.  
• New referral service for Looked After Children – led by the Greater Manchester Dental Commissioning Team and the Consultant in Dental Public Health, linking with local authority teams supporting healthcare for Looked After Children (LAC), a new referral service has been developed that will support all LAC in Greater Manchester and Cheshire and Merseyside to find a dental home. 
• Child Friendly Dental Practice (CFDP) Scheme – this service supports our specialist community services for children and reduces referrals and pressures into secondary care. Additional funding was provided by the PCB during 2022/23 for equipment to enable local anaesthetic dental procedures and fluoride varnish application.

Optometry

During 2022/23, there has been significant progress with key optometry services. This includes:

• This year, the Greater Manchester Urgent Eyecare Service (CUES) launched during Covid-19 saw 44,490 patients across the 10 Greater Manchester places, with more than 80 per cent of these wholly managed within the service, keeping patients out of general practice, A&E and hospital eye services.
• The CUES is being supported by efforts to raise patient awareness through the ‘get to know where to go’ campaign – jointly developed between Greater Manchester Integrated Care Board, Primary Eyecare Services, the Optometry Provider Board and Local Optical Committees.
• The past year has seen the extension of the Manchester locality glaucoma enhanced referral service across more localities, with a plan to cover the whole of Greater Manchester by mid-2023.
• Greater Manchester has led the way in implementing direct electronic referrals for ophthalmology from optometry practices. The project, initiated by the Greater Manchester Local Eye Health Network, in partnership with the Optometry Provider Board and Greater Manchester Confederation of Local Optical Committees, now has more than 99 per cent of practices engaged. In 2022/23, 54,518 referrals were sent electronically directly to hospitals or other appropriate destinations using the dedicated Opera platform.
• Technology enables optometry practices to share photographs and Optical Coherence Tomography scans with referrals to support triage and diagnosis in secondary care. 2022/23 saw 9,973 images included to support referrals.
• Data from the IT solution will be used as part of the emerging Optometry Excellence programme to further support quality improvement of referrals and development of education and training requirements for optometry clinicians.
• Funding was identified in 2022/23 to support an Optometry Excellence programme, including establishment of a steering group which has been planning for 2023/24. The programme will look to support continuous improvement and development in optometry, focusing on four themes: rescue and resilience; optometry referrals improvement programme; practical support networks; and sustainability.

General practice

During the last year:

• We have started to explore a partnership with the Clinical Research Network to establish more research opportunities for general practice and to support colleagues who are interested in research to explore opportunities of interest. 
• We were successful in bids to run health and wellbeing for our staff in general practice and remain committed to securing occupational health and employee assistance services for all.
• We have supported practices and localities by mediating during difficult situations.
• We have run and designed a number of development programmes to bring practices and primary care networks (PCNs) together for interactive learning and best practice sharing. 
• We concentrated on some governance changes for General Practice Board (GPB), as we have moved to being part of GMICP. We reduced locality representation to one member to enable effective board discussions and remain inclusive of all parts of the sector, federations, Local Medical Committees, PCNs, and all parts of practice, nursing and management.
• In March 2023, Dr Tim Dalton was appointed as the new chair of the GPB. A GP in Wigan, Tim’s term runs from 6 April 2023 for three years.

GP Excellence

During 2022/23, the GP Excellence Programme continued to provide a blend of training and development opportunities to general practice staff and PCNs across Greater Manchester.

Responding to ongoing challenges facing primary care, proactive and reactive action has been taken to ensure maximum uptake of offers.

Delivery of programmes has been aligned to practices and individuals within the four pillars of the GP Excellence Roadmap – rescue, resilience, improvement, excellence.

The team has:

• Co-delivered the monthly Greater Manchester Practice Managers’ Forum in collaboration with Greater Manchester workforce colleagues, covering a range of topic areas including financial wellbeing, workforce training and development opportunities and HR support, plus a dedicated session delivered by Dr Rachel Morris – ‘How to stay productive and avoid fatigue in the new ways of working’.
• Funded 50 places for practice managers to attain a nationally recognised accreditation through the Institute of General Practice Management, including weekly support drop-in and networking sessions covering each of the 10 domains within the accreditation framework. To date, 19 applicants have achieved accreditation, with the remaining participants working towards submission in May 2023.
• Provided 12 ‘pit stop’ Royal College of General Practitioners (RCGP) facilitated webinars covering Care Quality Commission (CQC) key themes. A total of 175 people attended, with 95 per cent stating they found the webinars useful.
• Provided bespoke support through the RCGP to three practices with a CQC rating of either ‘inadequate’ or ‘requires improvement’.
• Coordinated monthly clinical podcasts in collaboration with Primary Care Knowledge Boost, with average listening figures of 8,000 per episode.
• Facilitated individual coaching and mentoring sessions and provided bespoke support covering topics such as leadership, succession planning, skill mix review and workforce planning, understanding regulatory requirements, new to partnership, managing work/life balance and self-resilience.
• Supported the Greater Manchester primary care sustainability agenda, delivering two webinars for primary care staff across Greater Manchester.

Health and wellbeing

The last 12 months have seen the health and wellbeing programme develop its reach into frontline services to support primary care staff.

Activity included:

• Eight new Health and Wellbeing Podcasts released, all focused on wellbeing support for our frontline primary care services.
• A new series of Wellbeing Workshops launched. Participants rated their health and wellbeing knowledge as having increased from 6.8 to 8.5 following the session.
• 10,000 health and wellbeing leaflets delivered to every primary care workplace in Greater Manchester.
• Six wellbeing webinars delivered. These focused on managing stress, burnout and how to take control of your time and headspace.
• Workforce health and wellbeing questionnaire developed to improve data about the wellbeing of Greater Manchester’s primary care workforce.

Supporting our workforce

The major workforce achievement during 2022/23 has been the greater alignment between what primary care providers need and want from a workforce offer (including support and development), with the primary care team and workforce team at Greater Manchester Integrated Care Partnership.

This has meant reduced duplication of effort and clarity of understanding to provide a more collaborative, structured approach, increasing engagement with primary care providers. For the first time, we have established processes across primary care to collate workforce data. This will provide invaluable information for our providers to use in future.

Our Strategic Lead for HR and Workforce, Lynn Marsland, provides a vital role across primary care and has been available to support with all aspects of HR and workforce related issues. This has proven to be a much-needed resource, with both short and longer term support given around areas such as managing attendance, disciplinary, reception team development and ad hoc employment contract advice.

During the year, the Myers Briggs psychometric was used to support individuals and teams to develop. This was offered through the GP Excellence Programme.

Additional Roles Reimbursement Scheme (AARS)

During 2022/23, a workforce hub was developed on the PCB website, which includes access to information across a wide range of subjects, particularly to Additional Roles Reimbursement Scheme (ARRS) related job descriptions which was a request arising from PCNs and practices to help with standardisation and recruitment.

Previously, obtaining consistent ARRS-related data about numbers of roles, workforce plans and financial spend was extremely difficult across PCNs. In mid-2022/23, we established a Greater Manchester ARRS operational group to try to improve cooperation and understanding by involving former CCG workforce leads. Thanks to support from Kirsty Roberts from the Manchester locality and Johnny Henderson from primary care in NHS GM, we’re now deploying a triumvirate approach to coordination and oversight.

This group reported into the ARRS senior oversight group – jointly chaired by Rob Bellingham and Tracey Vell – where greater focus has been given to the ARRS budget. This has enabled us to offer PCNs access to the Greater Manchester underspend – including the agreement to match salary increases, where appropriate, for roles equivalent to Agenda for Change pay bands and National Joint Council equivalent roles employed by the voluntary and community sector. As a result, the overall Greater Manchester underspend has reduced significantly to approximately £4.6 million.

A key development in managing ARRS has been the ability to plan better for 2023/24, access good workforce data about roles that are difficult to recruit to, support PCNs and practices with a joint approach to maximise their take up of ARRS and to utilise any emerging underspend earlier in the year to ensure Greater Manchester is in a good position for future developments in 2023 and beyond.

Greener primary care

The PCB has been working to support environmental sustainability in primary care. A lot of work in the last year has been supporting the drive to better inhaler prescribing – that is better for asthma patients and better for the planet. This has been done by focusing on those who are over reliant on reliever inhalers, while encouraging the move to dry powder inhalers where appropriate. So far, this has dropped the greenhouse gas emissions from inhalers in Greater Manchester to the equivalent of taking more than 3,000 cars off the road.

The PCB is also supporting rollout of a 10-step plan for primary care sustainability. This plan is hosted on the PCB website and provides practices with a way of getting more involved in sustainability in their workplaces. 

Rising energy costs and concerns about the environmental impact of energy supplies have prompted the PCB to look at bulk energy purchasing options. This work is ongoing and will involve reviewing energy use in practices and considering whether there are ways we can reduce use and at the same time try to cut energy bills. 

Person-centred diabetes care programme

This CPD-accredited programme is funded by Greater Manchester and Eastern Cheshire Strategic Clinical Network and facilitated by the PCB, in partnership with the Personalised Care Institute.

It represents an exciting training opportunity for primary care practitioners across Greater Manchester to develop their skills in personalised care, when caring for patients with diabetes.

The programme consists of four core modules (shared decision making, motivational interviewing, personalised care support planning and SNOMED training) delivered through a flexible mix of e-learning, live webinars and interactive face-to-face workshops.

Having reached more than 200 participants during 2022/23, early feedback is very encouraging. As a result, the training is being extended. A full evaluation will be undertaken in July 2023, when the programme completes.

Clinically-led workforce and activity redesign (CLEAR)

Developing automated and information-led solutions for primary care is a priority for the PCB. We have worked with the CLEAR programme – recommended by Health Education England – using models which both support PCNs to engage widely with local partners and also interrogate data (mainly within EMIS in the first instance) to provide insight to understand patients most at risk, so that proactive monitoring and enhanced pathways of care can be enabled.

We have tested this methodology with two PCNs, with very positive feedback in relation to developing analytical skills, workforce planning for proactive care and building confidence among staff in the skills needed for these new ways of working. 

Digital First Primary Care

Together with Health Innovation Manchester, the PCB Managing Director and Clinical Lead are coordinating a Greater Manchester-wide programme to improve digital first patient access to GP services; improve staff ways of working; and optimise capacity management in practices and PCNs.

The Digital First Primary Care (DFPC) programme is part of a national initiative and is delivered on behalf of the Greater Manchester Primary Care Digital Board.

Key highlights during 2022/23 included:

• Extending the deployment of Primary Care Digital First Facilitators to support business change in general practices and PCNs.
• Delivering a proof of value pilot (the Lighthouse Project) and providing learnings for a centralised hub, supporting administrative functions for PCNs.
• Delivering training and learning to digital champions through the academy, which is jointly provided by our GP Excellence programme and Aqua.

GP providers, clinical colleagues and digital teams will continue to drive the DFPC programme to design digitally inclusive GP services to benefit citizens and the Greater Manchester system.

Closing statement

2023/24 will see the launch of the primary care blueprint, and we look forward to working in partnership with NHS GM to deliver the future of primary care across Greater Manchester.

There will be new opportunities for practices and providers to develop and grow through our PCN development programme, PCN leadership programmes, GP Excellence and locality primary care board development programme.

There will also be a focus on growing our Community Pharmacy Excellence, Dentistry Excellence and Optometry Excellence programmes during 2023/24 to make sure providers across all disciplines have access to ongoing development support. We will continue to support the health and wellbeing of our primary care provider colleagues, enabling them to be their best and provide excellent care to improve health and wellbeing throughout our communities