Power of Peer Review

Dr. Paul OliverChair, Clinical Lead,

Nottingham North and EastClinical Commissioning Group

Yale & SEPT July 2013

The Problem Stenhouse Practice overspend with a cost to

NNECCG at month six of £800,000 over budget.

*NNECCG (Nottingham North and East Clinical Commissioning Group)

21 Clinics

145,000 patients

£165m annual budget

S.M.A.R.T. Objective To reduce Stenhouse overspend by 20% (of

projected) by year end at 31 3 13 and to establish systems to bring Stenhouse in budget by 31 3 15

Root Cause Analysis A+E 237k

Critical Care 527k

Day Case 576k

Emergency 2,111k (148k)

OPD 1st 514k

OPD f/u 548k

OPD procedures 451k

Alternative Interventions

Focus Peer Review (T&O and Gastroenterology)

External Scrutiny

Targeted Peer Education and Support

Comparative AnalysisIntervention Empowering Expense

Peer Review Self EncouragingBuilds on Existing Strategy

Internal use of time onlySome restructuring of the day

External Reviewer A bit ‘Big Brother’ likeCould be Disempowering

Would cost 1-2 hours per day of additional clinical time

Periodic GPwSISupport

Educational and SkillDevelopingCould be Empowering

Would cost 1-2 hours per week for specific skill expertise and internal time

Select, Implement and Create Evaluation Plan

Select a Strategy-----Focus Peer Review

Implementation Plan-----Meet Daily, Review Guidelines, Share Good Practise

Creating an Evaluation Plan-----CCG feedback monthly to practice, focus on non urgent GP driven activity, review at year end

Preliminary Results

Direct

Acces

s

Day Cas

e

OP First M

ulti Pro

fessio

nal

OP First S

ingle

Profes

sional

OP Follow-u

p Multi

Profes

sional

OP Follow-u

p Single

Profes

sional

OP NON FACE2FACE

OP Proce

dure

OP UNBUNDLED

Grand T

otal

-£50,000

£0

£50,000

£100,000

£150,000

£200,000

£250,000

Estimated post intervention saving

I am Happy Logical and easy to follow

Follows what I know from P.R.I.D.E. and 4DX

Empowering

Transferable

Delivers

Encouraging

Reflective

Thank You