primary care – changing future 1 primis 23 rd april 2002 metropole birmingham
TRANSCRIPT
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PRIMIS 23rd April 2002Metropole Birmingham
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Primary Care
The changing future
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What will change?
• What we do
• Who we work with
• How we plan, develop and deliver services
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What will change?
• What we do
• Who we work with
• How we plan, develop and deliver services
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The Concept of MigrationV
olu
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f Activ
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Dista
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HomePracticeLocalityDGHSub Regional
RegionalSupra Regional
National PCT
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What will change?
• What we do
• Who we work with
• How we plan, develop and deliver services
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Partnerships
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Primary
Care
Secondary
Care
Social
Services
Planning for change
Intermediate care
Operational Strategic
Referral and discharge protocols
Maximising independence
Discharges and delayed discharges
Balancing capacity and
demand
Throughput planning and
admission prevention
Health promotion and
disease prevention
Integrated service
planning and delivery
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What will change?
• What we do
• Who we work with
• How we plan, develop and deliver services
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KEY WORDS
Prio
rit y
Quality
Access
Equity
Demand
Supply
Modernisation
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Demand Capacity
Met need
Unmet need
Service demand and capacity
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Demand management?
The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.
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Demand management?
The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.
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Demand management?
The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.
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Demand management?
The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.
Triage for primary care
Prevention
Self-care
Community multidisciplinary teams - care at home
GP booking schemes
NICE referral guidelines
Priority scoring systems
Form referral letters
Direct booking at O/P appointments
Nurse led pre-assessment clinics
Clinics outside normal working hours
Consultant out-reach clinics
GP clinical assistants in O/P
PCT held waiting lists
Waiting list validation Facilitated early discharge
Intermediate care services
Hospital at home schemes
One stop rehab teams
Email consultation
Telemediine
GP specialists
Different use of GP time
Alternatives to GP
Systematic secondary prevention in primary care
Survey high DNA rates
Develop DNA policy
“Follow up” reviews
Primary based alternatives to hospital delivery
eg minor surgery
Triage for secondary care
PATIENT GP O/P REFERRAL O/P CLINIC WAITING LIST PROCEDURE DISCHARGE
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Demand Capacity
Met need
Unmet need
Adjusting referrals
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Demand Capacity
Met need
Unmet need
Adjusting referralsWhole HA
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5
10
15
20
25
ENT referrals to SUHT per 1000 patients
1:3 referrals may be avoidable
1:6 referrals may be avoidable with targeted GP education
110%
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Demand Capacity
Met need
Adjusting referralsWhole HA
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5
10
15
20
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ENT referrals to SUHT per 1000 patients
1:3 referrals may be avoidable
1:6 referrals may be avoidable with targeted GP education
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Demand Capacity
Adjusting referralsWhole HA
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5
10
15
20
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ENT referrals to SUHT per 1000 patients
1:3 referrals may be avoidable
1:6 referrals may be avoidable with targeted GP education
Met need
Met Filled
Protocol driven referrals
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Demand Capacity
Met need
Unmet need
More than 10%imbalance
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Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
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Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
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Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
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Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
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Unmet need Capacity filled
Must have secondary care
Could be done in primary care
Adjusting services
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Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
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Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
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Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
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Demand Capacity
Could be done in primary care
Adjusting services
Must have secondary care
Protocol driven referrals
orthop refs per 1000 ptnt
0
5
10
15
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25
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Practices anon
Act
ivit
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1000
pat
ien
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orthop refs per 1000 ptnt
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10
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Additions to orthop IP list per 1000 ptnt referrals not listsed per 1000 ptnt
% of IP additions to refs
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39
% of IP additions to refs
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Endoscopy services
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• Nuffield access equates to high referrals
• Average gastroscopy activity is 5.4 per 1000 population
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Nuffield Annual rate per 1000 pop
SUHT Annual rate per 1000 pop
Activity rates - City PCT
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Expectation of need• BSG Working Party Report 2001
City PCT Activity Activityper 1000 pop per 250000 pop 246000 pop % of expected
Diag Upper GI 10 - 15 (av 12) 3000 1334 44%Flex Sig 2.00 - 2.25 550 182 33%Colonoscopy 2.5 - 5.0 800 327 41%Colonoscopy Average to plan for 2250
ProcedureAverage Expected
Put these figures back to the upper GI diagnostic graph
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• Nuffield access equates to high referrals
• Average gastroscopy activity is 5.4 per 1000 population
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6.0
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14.0
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Nuffield Annual rate per 1000 pop
SUHT Annual rate per 1000 pop
Activity rates - City PCT
Average
Expected
Expected increase
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Expectation of need• BSG Working Party Report 2001
City PCT Activity Activityper 1000 pop per 250000 pop 246000 pop % of expected
Diag Upper GI 10 - 15 (av 12) 3000 1334 44%Flex Sig 2.00 - 2.25 550 182 33%Colonoscopy 2.5 - 5.0 800 327 41%Colonoscopy Average to plan for 2250
ProcedureAverage Expected
More procedures needed for City:Upper GI diag 1646Flex Sig 368Colonoscopy 473Total 2487 or 50 procedures per week
60 extra NHS procedures per week if include Nuffield activity27 MORE colonoscopies per week predicted by BSG
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Primary care managing throughput
• Delayed discharges (5/95)• Managing care• Managing waiting lists
– Clinically– Comparatively
Primary Care
Secondary Care
Referredpatients
Discharge
•Poor management of referred patients during wait
•Poor management of waiting lists
•Little co-ordination between various agencies
•Protracted affair
•Push system
•Delay inevitable
Reduced independence
Pre-intervention and reablementfunction
Primary Care
Secondary Care
INTERVENTION
Best independence
Reabling independence
Admission avoidance
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Balance
• Between demand and capacity
• Between availability and need
• Between needs and wants
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PRIMIS
23rd April 2002Metropole Birmingham