why the changes? - healthcare conferences uk ltd€¦ · president –association of surgeons in...
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Professor (Hon)Vijay Kumar FRCS(Edin) MRCGP
Chair-Royal College of General Practitioners –Yorkshire
President –Association of Surgeons in Primary care
Member National council of Presidents-Association of Surgeons of Great Britain & Ireland
Commissioning lead-Royal College of General Practitioners-
Yorkshire
NHS England
Local Authorities CCG
Health and Wellbeing
Boards
Local Healthwatches
Providers
FTs regulated and licensed by Monitor (economic) and all providers
regulated by CQC (care quality)
Public Health England
Department of Health THE NEW FIT…
WHY THE CHANGES?
THE CURRENT STRUCTURE-Separate workings
The Government’s aims for the Health and Social Care Act
A stronger voice for patients:
Patient-centred care – “No decision about me without me”
Creation of Healthwatch England within the CQC and Local Healthwatch organisations to represent the voice of service users
Focus on patient outcomes rather than processes
Extend choice and competition
Overhaul of the commissioning structure Increase autonomy of providers with all NHS trusts becoming
foundation trusts (FTs)
New approach to provider regulation – creation of a licence issued by Monitor
Savings of £ 15 Billion over 3 years (?)
Perception of a doctors surgery?
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OUR CURRENT PRIMARY CARE CENTRES
WRONG!
Surgical/orthopaedic/Opthalmology/Urology/diagnostics/ & Dermatology/other Speciality community centres
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Newton abbott hospital -1992
GP Surgery/Community surgical unit 2009 –yorkshire
GP SURGERY/Community surgical unit 2014-NW
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Various Endoscopies in the community health centres
Ultra Sound guided invasive procedures
Level 1 – these services can be provided by
Gp’s with basic surgical skills in a basic
minor op /treatment room:
1. Sebaceous cyst,
1. Lipoma less than 2cm,
2. In-growing toe nail;
3. Excision of small lumps and bumps
4. Chalazion
5. Injection of Joints and Bursae
6. Cryotherapy
7. Aspiration of cyst
And those mentioned in the New GMS
contract(2004)
Level 2-
These can be delivered by Consultants /
GPwSI/ PsI with enhanced Surgical experience
from a modified Treatment room/Operating
theatre:
1. Vasectomy
2. Carpal tunnel decompression
3. Ganglion of the wrist(Dorsum)
4. Zadeks for IGTN
5. Ligation of varicose veins
6. Haemorrhoids injection
7. sigmoidoscopy
8. Gastroscopy
9. Cystoscopy
10. Caudal Blocks
These services can only be performed by
qualified and trained surgeons in a
primary care setting from a fully
functional operating theatre:
1. Inguinal hernia
2. Repair femoral hernia
3. Repair epigastric hernia
4. Umblical hernia repair
5. Large lipoma’s
6. Circumcision
7. Frenuloplasty of the penis
8. Re Do CTD
9. Colonoscopy
10. Reversal vasectomy
11. Highlight Ligation and stripping of
varicose veins
Other examples can be delivered from a
Primary care setting include:
1. Ophthalmology:Phako cataract
surgery,Lid surgery,
2. Dermatology- Scc Procedures
3. Urology-Urodynamics
4. Plastic surgery-Dupuytrens Fasiectomy
5. ENT – laryngoscopy
6. Gynaecology-Colposcopy
7. Radiology – diagnostic ultrasound,Echo
8. Pain clinic
Advantages of shifting appropriate surgical procedures to a community setting include :
1. Easier access & free car parking facilities.
2. Familiar setting.
3. No struggle around time of operations.
4. Patient in surgery for a short period of time and performed under local anaesthetic.
5. One stop clinic in the majority of cases./No stay’ surgeries.
6. DNA (did not attend) percentage is a fraction as compared to hospitals.
7. Continual care at the practice./Few problems arise.
8. Close care in regards to home rehabilitation.
9. If a follow up is required they can be seen by the same carer.
10. High satisfaction./CCG satisfied: low cost surgery.
11. Fully accountable service. /Improved integration between primary and secondary care.
12. High volumes of minor and intermediate and such trainees have excellent hands on
access to training skills .
13. Frees up more space, so that patients who need hospital care, can be given with quicker
access.
Early 2000’s to 2014-Traditional “new” model of care –American HMO’S considered as goods example for the NHS
DH/PCT Trips out to Kaiser Permanante Oaklands –North San Francisco Centre
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Blue Cross & Blue Shield of California-Sacremento
Link With Doncaster since 2009
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Dalton review
Models…deployable at an enterprise, group of services or service level
• Locality based single or multi-site trust
• Federations (e.g. UCL Partners)
• Service level chain (e.g. Moorfields)
• Joint venture (e.g. GSTS Pathology; SWLEOC)
• Management/operational franchise (Circle at Hinchingbrooke was the main example )
• Geographically dispersed multi-service chain (e.g. BMI)
• Vertically integrated care organisation (Tameside)
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VANGUARD SITES
Bid For Interest in 2015 Multi-speciality Community Providers-INCLUDING
SURGERY IN THE COMMUNITY
Primary and acute care systems
Urgent care Networks
Viable smaller hospitals
Specialised care
Modern maternity services
Enhanced healthcare in Nursing Homes
£250Million of new money
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The Response 260 APPLIED AND 29 SELECTED Rest to be followed up with action plan
Integrated Primary and Acute Care Systems – joining up GP, hospital, community and mental health services
1. Wirral University Teaching Hospital NHS Foundation Trust
2. Mansfield and Ashfield and Newark and Sherwood CCGs
3. Yeovil Hospital
4. Northumbria Healthcare NHS Trust
5. Salford Together
6. Lancashire North
7. Hampshire and Farnham CCG
8. Harrogate and Rural District CCG
9. Isle of Wight
Multispecialty Community Providers – moving specialist care out of hospitals into the community 10.Calderdale Health and Social Care Economy 11.Derbyshire Community Health Services NHS Foundation Trust 12.Fylde Coast Local Health Economy 13.Vitality 14.West Wakefield Health and Wellbeing Ltd 15.NHS Sunderland CCG and Sunderland City Council 16.NHS Dudley CCG 17.Whitstable Medical Practice 18.Stockport Together 19.Tower Hamlets Integrated Provider Partnership 20.Southern Hampshire 21.Primary Care Cheshire 22.Lakeside Surgeries 23.Principia Partners in Health
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OUR MANTRA ! YOU WANT IT –we will be getting it
WHERE DO WE STAND in England … Specialist surgical procedures which are BEING delivered from a primary care setting: Ophthalmology incl cataracts(100%Increase) Dermatology Urology ENT Gynaecology Radiology Gastroenterology Hernia;s Newer models OF AQP For 2015- : Vascular Surgery! Haemorrhoids rx Contracts for arthroscopy
Joint working Procedures in Primary care-GP-Consultants New Members on Board
• Average 2 weeks from GP referral to first appointment in your doctors surgery
• 1-2 weeks from consultation to surgery
Short wait times
• our consultants operate in local centre with all the facilities you’d expect & low infection rates
Surgical treatment
• 99.8% of our patients rated our service good to excellent
• We achieved 100% of NHS quality targets (CQUINS)
Quality of care
• Outpatient clinics in your local GP surgery, rehabilitation using local physiotherapy services
Local to you
• From referral to consultation, diagnosis & treatment – you’ll see the same consultant at every stage of your journey
Continuity of care
• You’ll be given a named contact from our patient liaison team to help you manage your appointments and answer any questions you may have
Patient liaison team
THREATS
Care Quality Commission-What are they looking for? CQC Stops Dr From Practising-April 2015 Revalidation- Patient complaints- Expectations- 14,000 GMC complaints a year-incl.On Line, NCAS issues. Premises-DDA/Liability Poor Recruitment Increased staff costs Lesser Re-embursement
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Thank You
Questions ?
My Contact details-
ASPC/ASGBI [email protected]
Direct- [email protected]
My Local PA [email protected]
The VIEWS EXPRESED HERIN ARE ONLY MINE AND NOT OF ANY ORGANISATION QUOTED ABOVE
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