1 nicky brooks development manager practitioners with special interests team natpact
TRANSCRIPT
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NICKY BROOKSDEVELOPMENT MANAGERPRACTITIONERS WITH SPECIALINTERESTS TEAM NatPaCT
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PwSIs and Impact Assessment
• Background• National Impact Assessment • The Impact Assessment Tool for Local Work
• Case studies
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Background
• Experience of meeting PCT staff across England
• Issues around choosing the most appropriate measure
• Issues around baseline measures• Need for a tool with a menu of options for
local services
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National Impact Assessment
• MA Action on Programme (October 2002) • www.york.ac.uk/inst/yhec • Compilation of 6 GPwSI pilot sites• Consistent objectives – increase access, reduce
waits, streamline patient journey, develop / spread best practice and link 1 / 2 care
• GPwSIs dealt with range of conditions • At time of the evaluation 5/6 of the services been
established 9 months or less http://www.york.ac.uk/inst/yhec
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National Impact Assessment• Process related findings• Activity analysis 30-40% referrals 2 care could be managed by
GPwSI70-80% patients discharged back to GPReduced follow up ratio in 1 care15-20% patients ref. consultant opinion or direct
onto WLLow DNA rates 1-2%Capacity 1 clinic per week 9-10 patients (p.a.
420-500 / 320-400 new patientsSurgical GPwSI 4 adult tonsillectomies per week
150-180 p.a.
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National Impact Assessment
• Weekly clinic without audiological support Workload for 75,000 approx
• With audiological support 120-150,000• Patient satisfaction surveys unanimous praise• ENT consultants largely positive, • GPwSIs enjoyed challenges
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National Impact Assessment
• GPwSI Orthopaedic Services University of Leicester (May 2003)
• www.le.ac.uk/cgrdu/pcd.html /pcd.html• Involved 3 city centre PCGs• RCT to test GPwSI in 1 / 2 care• Treating back and knee problems• Service objectives – to improve patient
management, reduce inappropriate referrals, and deliver good health status and patient satisfaction
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National Impact Assessment• Little difference between two methods of
delivery• Initial waits GPwSI 7 weeks Consultant 17 weeks,
increased to 13 weeks and 19 weeks• 70% patients discharged back to GP after 1
appointment• 9% seen 3 times or more• Main interventions: advice, prescription, X- ray,
manipulation, injection• 5% referred onto Consultant• QOL first 3 months improved• Patient satisfaction largely positive (15 / 263
patients had negative comments
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National Impact Assessment
• GPs in PCG 80% return – 82% had referred into service
• More than 80% happy with outcomes• Consultants 100% return - 50% had seen
patients from GPwSI clinic• 7 agreed with treatment given• GPwSI referrals to ENT Consultant 6/10 mostly
appropriate
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National Impact Assessment
• Specialist PwSI Clinics Kings Fund (December 2004)
• www.sdo.ishtm.ac.ukw.sod.isthmus.ac.auk• Service objectives – access, patient / clinician
satisfaction, costs to the patient and the NHS• Final report not yet available – interim report• Waits / case mixMean wait 38 daysDNAs 7.4%Cancellations 2%
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National Impact Assessment• Outcomes37% PwSI follow up22% discharged8% sent back to GP6% referred to hospital1% awaiting test results1% sent elsewhere23% data missing
• Reasons for referralAdvice on clinical management 68%Having a procedure 47%
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National Impact AssessmentSeeking a diagnosis 30%Second opinion 23%• ½ GP using services reported quicker waiting
times• 1/3 GPs using the services reported lack of
clarity of referral guidelines • Wide variations in accrediting GPwSIs, training,
CPD• Lack of clarity about where responsibility lay• Costs and value for money difficult to establish
due to ‘free goods’
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National Impact Assessment• Primary Care Dermatology Service, University of
Bristol (April 2005)h www.sdo.ishtm.ac.ukw. • Effectiveness, cost effectiveness, accessibility
and acceptability • RCT comparing care with usual hospital care • Triage in acute care with Consultant and GPwSI• Measures disease specific and global QOL,
patient views on accessibility, DNA rates and waiting times
• Process measures – what happens to patients once referred
• Economic analysis – including costs from a societal perspective – NHS and patients
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The Impact Assessment Tool• Two main aspects1. Areas to consider when designing PwSI services2. Options for evaluating the impact of PwSI services• Areas to consider when designing PwSI services:Objectives of a PwSI service
Is the service able to provide comparable care?Does the service offer value for money?Is the service providing patient-centred care?What is the impact of the service on staff working in 1/ 2
care?
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The Impact Assessment Tool
• Options to considerProvides references to existing websites with
resources and some specific tools already tried and tested
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Case Study One
• COPD PwSI ServiceService outline:GPwSI 2 sessions per week (1 clinic, I
developmental / educational) NwSI 6 sessions per week (1 clinic, 5
developmental / educational)
What would be your short, medium, long term objectives and impact assessment measures?
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Case Study Two
• Heart Failure PwSI ServiceService outline:GPwSI 1 session per week (one stop clinic) Pharmacist 1 session per week (one stop clinic)NwSI 10 sessions per week (1 clinic, 9
developmental / patient review/ care) What would be your short, medium, long term
objectives and impact assessment measures?