choice across boundaries katherine foreman director of modernisation colchester pct
TRANSCRIPT
Choice across Boundaries
Katherine Foreman
Director of Modernisation
Colchester PCT
Map of Essex showing locations of PCTs and Hospitals
Key:
Basildon PCT (contains Basildon and Thurrock University Hospitals NHS Trust)
Billericay, Brentwood and Wickford PCT
Castle Point and Rochford PCT
Chelmsford PCT (contains Mid Essex Hospital Services NHS Trust)
Colchester PCT (contains Essex Rivers Healthcare NHS Trust)
Epping Forest PCT
Harlow PCT (contains Princess Alexandra Hospital NHS Trust)
Maldon and South Chelmsford PCT
Southend on Sea PCT (contains Southend Hospital NHS Trust)
Tendring PCT
Thurrock PCT
Uttlesford PCT
Witham, Braintree and Halstead PCT
Major Town
Town containing a PCT Trust HQ
Town containing a Hospital and a PCT Trust HQ
User choice is at the heart of the Government’s agenda for public
sector reform
Principles for public sector reform• High national standards and clear accountability• Devolution of responsibility • More flexibility • Choice and diversity of
provision
Why Choice? Two key reasons:• Meet Rising Consumer demand for more choice
and more control over services
• Provide new incentives on the providers of public services to ensure they are responsive to users needs
– and, within Health, we having growing evidence that empowered and engaged patients experience better clinical outcomes
We know patients want more choice within the NHS
0 20 40 60 80 100
Choice of Hospital
More information
Choice of Surgeon
Choice of Alternative Medicine
Choice of Treatment
PublicGPs
NB: Only 3% (8% in over 65s) did not want any of these choices
Source: Mori
NB. Only 3% (8% in over 65’s) did not want any of these choices
Source: Mori
How do we organisationally involve patients?
• Patient Executive Committee
• Patient Forum
• Patient on each sub committee
of professional Executive Com.
and Board
• Advice service
How do we offer choice?
• Choose and Book – NHS/independent
• Chronic Disease Management
• Redesign of services
• Agenda for Change
How do we promote choice?
• Referral & Booking Centre– Provides earlier access for orthopaedic/musculo-
skeletal referrals
– One central point
– Triage
– Patient agrees date
– Seen and treated
• Roll out plan for other
specialties
Helping patients to choose
• GP Care Advisers
• Patient Choice Advisers
• Referral & Booking Advisers
• Patent Advice & Liaison Service
An example of patient involvement
• Walk In Centre– Site?– Staffing?– What services within Walk In Centre?– Help with promotion of this development– Public consultation on developing services
Redesigning nursing roles
• Patient part of Urology Steering Group– Nurse led prostate assessments– Cystoscopy sessions– Andrology clinics
• All provided from
a town centre location
Men’s Health Action Group
Chronic Disease Management
• 17.5 million people with chronic diseases accounting for 78% of health care costs
• 72% of contacts with NHS each day are in primary care; 24% in an acute setting and 4% A&E/WIC and NHSD
• The majority of funding is within the acute sector, but not where the majority of care is provided
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TE Comparing KP and NHS
• In many ways KP is like the NHS, providing a similar range of services for a population equivalent to that of a small country.
• KP is roughly the same age as the NHS.
• Unlike the NHS, Permanente physicians cannot work outside the system.
Feachem, et. al., BMJ January 19, 2002
• Unlike the NHS, KP does not serve the entire population of a geographic area but rather operates in a competitive environment.
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Segments within the total population
Costs associated with each segment
Those w/no chronic conditions
Those w/one chronic condition
Those w/multiple chronic conditions
People $$$
72%
21%
6%
36%
31%
33%
Source: Kaiser Permanente Northern California commercial membership, DxCG methodology, 2001.
Chronic Illness Drives Medical Care Costs
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More than Care & Case Management
Intensive
or Case Management
Assisted Care or Care Management
Usual Care with Support
Level 170-80% of a
CCM pop
Level 2High risk members
Level 3Highly complex members
Targeting Population(s)
Redesigning Processes
Measurement of Outcomes & Feedback
Hidden Health Care SystemHidden Health Care System
SelfSelf--CareCare80%80%
Professional CareProfessional Care20%20%22
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DIVISION OF ACTIVITYDec 02 to Dec 03
NB Community activity comprises of:
• Self referrals
• GP direct
• Practice nurses
• consultants
• GP via consultant
• GP via hospital respiratory nurse specialist
• Follow-up from Cornerstone
• Regular community follow-ups to community pts. (not ESD)
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140
Dec-Mar Apr-July Aug-Nov Dec '03
ESD
TIMELY
COMMUNITY
Bed days saved
42
88
55
191
72
226
179193
0
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100
150
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250
Dec-Mar Apr-July Aug-Nov Dec '03
ESD 2ndry careAdm avoidance
• Over 80% of all medical symptoms are self-diagnosed and self-treated without professional care.
• Patients are the true primary care providers of medical care for themselves and their families.
• How can health care systems educate, equip, and empower the true primary care providers… patients?
Self-Care: Patients as Providers
Patient attending Expert Patient Programme‘I did not realise how serious my diabetes was at first. Perhaps I might have taken it more seriously if I knew then what I know now’.
Rehabilitation
• Physiotherapy
• LEAP – Life Enhancing Activity Programme, Leisure World Colchester
• Phoenix Club
• Expert Patient
Programme
Linking services for easier access
Integrating services for easier access
• Colchester CAB, Cruse, Relate, Epilepsy Action, Friendship First, Minority Ethnic Partnership, Young Peoples service,Family Planning, Continence Clinics, Cancer Care, Pension Agency, Social Workers, GP Care Advisers, PALS, District Nurses, COPD Team, Advice Centre, Urology Service, Mens Health Action Group, Diabetes Nurse.
What can we learn?
• Proactive approach to ‘patient centred’care
• Use analysis to target ‘at risk’ groups
• Abolition of boundaries
• Role of commissioning and choice as drivers to integration
• Knowledge is not enough to change behaviour
Choices for staff
• Culture matters……..– Communication– Appreciating others– Teamworking/coaching/mentoring
• Type of contracts & flexible approach
• Availability of perks: Childcare adviser
• Celebrate achievements & publicise
Agenda for Change
• Promote public health messages as generic part of all staff job descriptions
• Review vacancies with line manager to consider opportunities for more flexible workforce
• Work with Human Resources Dept to review how we manage staff who are
off sick • Redesign workshops
Redesign roles
• Extended Scope Physiotherapists/ consultants
• Practitioners with a special
interest
• Generic roles to make work more interesting – ophthalmology
secretaries
Environmental factors matter
