extended primary care service evaluation ... - southwark ccg · southwark • access to patient...

Extended

Primary Care

Service

Evaluation:

Emerging

Findings

February 2017Draft for discussion

2

Draft for discussion – Subject to change

Important Notice from Deloitte

This working note has been prepared by Deloitte LLP (“Deloitte”) for Southwark Clinical Commissioning Group (the “Client”) under the terms of the contract with them Client dated 26 April 2016 (“the Contract”) and on the basis of the scope and limitations set out below.

The working note is not a deliverable under the Contract and will be superseded by the deliverables when these are issued to the Client. The working note is issued to the Client for discussion purposes only, and specifically to discuss emerging findings from the work to support low income groups with the co-payments in General Practice. Our work is incomplete and remains subject to our internal review procedures. Accordingly any subsequent deliverable may reflect substantially different contents, views and conclusions dependent upon our further work and consideration of the issues involved. No reliance should be placed upon this working note for any purpose, nor may it be shown, quoted or referred to any other party. We accept no responsibility or liability or duty of care to any party whatsoever in respect of the contents of this working note.

3


Table of contents

1. Context: background of the EPCS evaluation project

2. Patient experience of the EPCS

Key findings

Friends and Family Test results

Findings from patient surveys

3. EPCS Activity

Overall EPCS appointments by month

Utilisation percentage

Demographic breakdown

EPCS appointments by practice

Daily usage of the EPCS

EPCS prescribing mix

4

Background

5


Background

Background and current development of the EPCS

Background of the EPCS

NHS Southwark Clinical Commissioning Group (CCG) has commissioned the Extended Primary Care Service (EPCS) to provide additional GP and nurse appointments for Southwark patients 8am - 8pm, 7 days per week. This service is delivered by groups of GP practices working together in GP federations, Quay Health Solutions (QHS) in the north and Improving Health (IHL) in the south. The service is delivered at two sites:

•North: Bermondsey Spa Medical Centre – 50 Old Jamaica Road, London, SE16 4BN

•South: Lister Primary Care Centre - 101 Peckham Road, London, SE15 5LJ

The aim of the service is to improve access to GP and practice nurse appointments to everyone registered with a GP practice in Southwark. To access the service, patients telephone their GP practice where a GP/nurse will speak to them and, if they need a same day or next day appointment, they can book the patient into the EPCS at a convenient time. The service is intended to be an extension of a patient’s GP practice, however, it is not aimed at patients with complex health conditions who require continuity of care from their regular GP practice.

Southwark CCG has commissioned Deloitte to undertake an evaluation of the EPCS. This evaluation is targeted at understanding whether the scheme has been successful to date in improving access to primary care. The evaluation is based upon data analysis, stakeholder engagement and a patient and staff survey.

This presentation summarises some of the key findings emerging from the data analysis and patient surveys undertaken. The results presented in this slide pack are provisional and subject to change.

6

Background

The EPCS operates from two locations across Southwark

North – QHSBermondsey Spa Medical

Centre50 Old Jamaica Road, London, SE16 4BN

Working with 24 practicesLive in November 2014

South – IHLLister Primary Care Centre101 Peckham Road, London, SE15 5LJ

Working with 20 practicesLive in April 2015

Total population covered: c. 300k

7


Aims of the EPCS

The EPCS aims to improve access to primary care services through commissioning of additional primary care capacity

Improve access to primary care services through commissioning of additional primary capacity.

Extended Primary Care Service

Patients

• Ensure improved and consistent access to high quality primary care services

• Support patients to find the right service at the right time, through integration of access routes to urgent and core primary care services, with consistent redirection at all points.

• Improve patient experience and health outcomes

Providers

• Free up capacity within practices to manage scheduled care and care of patients with long-term conditions

• Promote consistency and reduce variation in access arrangements across practices

• Facilitate information sharing between primary care settings enabling greater continuity of care

• Provide care in a flexible and effective way that responds to patient needs e.g. exploring use of technologies and non-face to face contacts.

• Promote closer and more effective working with local pharmacists and other services.

Commissioners

• Improve and enhance current primary care capacity through pooling of resources from different out of hours funding streams, practices and additional CCG funds

Service overview

• 8am – 8pm, seven days a week

• Both GP and nurse appointments

• Rapid telephone management by clinicians to support demand management

• Two sites in North and South Southwark

• Access to patient information

• Redirection from other services (SELDOC, A&E, 111)

Source(s): EPCS service specifications, EPCS Business Case document

8

Patient experience

9


Key findings

This slide summarises key findings around patient experience based on survey data and feedback received by the service

Friend and Family Test responses

• Friends and Family Test (FFT) data shows that the EPCS is regarded positively by patients. 92% of those responding to the FFT at QHS said they would recommend the service to other people.

• In QHS’ FFT questionnaire, When asked where patients would go if they were not referred to the EPCS that day, patients noted A&E, urgent care centre, and other walk-in healthcare service providers as the main alternatives.

Patient survey responses

• From recent patient surveys, 100% of responses from patients who visited the EPCS had good experiences there.

• More than half (57%) of patients surveyed noted that with EPCS it has been easier to get an appointment.

• More than half (57%) of those who did not use the EPCS stated their the main reason as being able to get a GP appointment at their own practice.

• 59% of patients who have not used the EPCS expressed interest in the service.

10


QHS EPCS FFT results (Nov 2016): How likely are you to recommend our service to friends and family if they needed similar care of treatment?

Findings from Contractual indicators and F&FT

FFT findings indicate positive patient experience with the EPCS across both North and South hubs

• At IHL, 94% of patients who visited the EPCS expressed satisfaction with the service. 68% found the service easy or fairly easy to access. 85% were satisfied with their contact with receptionists in the EPCS.

• FFT from QHS show an average of 92% “extremely likely” or “likely” to recommend the EPCS to friends and family.

• It was also found that, in QHS, for some patients, if they had not gone to the EPCS, they would have visited A&E or gone to the walk-in centres for treatment.

56%

34%

2%

1%

1%

6%

0%

Extremely Likely

Likely

Neither likely or unlikely

Unlikely

Extremely unlikely

Don't know

N/A

IHL patient satisfaction (Dec 2016)

94%

68%

85%

Patient satisfaction

Patient satisfaction on access

Patient satisfaction on contact

11


Summary of findings from patient surveys

Summary findings from the patient survey are presented below

• 279 survey responses were received

• 14 survey questions were asked on patient’s views on GP appointments and the EPCS

• 90% of patients surveyed have seen a GP in the past year

• 51% of patients surveyed found it more difficult to get a GP appointment in the past year

• 72% of patients surveyed have not heard of the EPCS

• 39% of patients surveyed have used the EPCS in the past year

• 57% of patients surveyed who used the EPCS have found it easier to get a GP or nurse appointment in the last year

• 100% of patients surveyed who used the EPCS before have had positive experiences

• 76% of patients surveyed responded that they will likely use the EPCS again

• 57% of those who have not used the EPCS noted the main reason is that they were able to get an appointment with their GP

• 59% of those who have not used the EPCS have expressed interest in the service

The following slides present responses to specific questions posted in the patient survey.

12


How did you get your appointment (select all that apply)?

238 out of 279 answered

83.6%

23.5%

12.6%8.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Telephone Walk-in Online booking Other (please

specify)

Telephone 83.6% 199

Walk-in 23.5% 56

Online booking 12.6% 30

Other (please specify) 8.4% 20

13


Has the Extended Primary Care Service made it easier to get an appointment with a GP or nurse?


19.0%

38.1%

19.0%

0.0%

0.0%

14.3%

9.5%

A lot easier

Easier

Unchanged

Harder

A lot harder

Don't know

Other (please specify)

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%

A lot easier 19.0% 4

Easier 38.1% 8

Unchanged 19.0% 4

Harder 0.0% 0

A lot harder 0.0% 0

Don't know 14.3% 3

Other (please specify) 9.5% 2

14


Overall, how would you rate your experience of the Extended Primary Care Service?


61.9%

38.1%

0.0%

0.0%

Very good

Good

Poor

Very poor

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

Very good 61.9% 13

Good 38.1% 8

Poor 0.0% 0

Very poor 0.0% 0

15


How has contacting your local practice changed over the last 12 months?


6.4%

16.2%

44.1%

16.2%

11.8%

5.4%

A lot easier

Easier

Unchanged

Harder

A lot harder

Not applicable

0.0% 10.0% 20.0% 30.0% 40.0% 50.0%

A lot easier 6.4% 13

Easier 16.2% 33

Unchanged 44.1% 90

Harder 16.2% 33

A lot harder 11.8% 24

Not applicable 5.4% 11

16


Would you like the option to visit the Extended Primary Care Service (with full access to your health records, with your consent)?


37.9%

20.6%

19.2%

7.0%

15.4%

5 - Yes, a lot

4

3

2

1 - No, not at all

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

5 - Yes, a lot 37.9% 81

4 20.6% 44

3 19.2% 41

2 7.0% 15

1 - No, not at all 15.4% 33

17

Activity

18


QHS EPCS appointments(Apr 2015 – Nov 2016)

IHL EPCS appointments(Nov 2014 – Dec 2016)

EPCS overall appointments by month

EPCS utilisation has steadily increased since inception across both North and South hubs

0

500

1000

1500

2000

2500

2014N

ov

2014D

ec

2015Ja

n

2015Feb

2015M

ar

2015Apr

2015M

ay

2015Ju

n

2015Ju

l

2015Aug

2015Sep

2015O

ct

2015N

ov

2015D

ec

2016Ja

n

2016Feb

2016M

ar

2016Apr

2016M

ay

2016Ju

n

2016Ju

l

2016Aug

2016Sep

2016O

ct

2016N

ov

2016D

ec

SELDOC practice booked (Extended access) Other bookings

0

200

400

600

800

1000

1200

1400

SELDOC practice booked

• A total of around 58,000 appointments have been delivered in the EPCS access hubs since launch

• Practice referrals have steadily risen for both IHL and QHS

• IHL monthly usage show seasonal trends – the EPCS is utilised more intensively during winter months

• SELDOC (Out-of-hours service) also uses the EPCS, generating around 10% and 15% of total referrals for IHL and QHS respectively.

19


EPCS utilisation %(Nov 2014 – Dec 2016)

EPCS Utilisation % by month

Utilisation as % of available appointments has risen

0%

20%

40%

60%

80%

100%

QHS IHL

Note: Utilisation % is obtained by dividing the total number of referrals by total available appointments,in a given period of time

• Average utilisation has grown from 37% when the service went live to 61% in November 2016 for QHS; for IHL, utilisation has grown from 26% in November 2014 to 74% in December 2016.

• At the moment, utilisation rates are similar across QHS and IHL. In the period June 2016 to November 2016, IHL monthly utilisation was 56% and QHS monthly utilisation was 59%.

• It should be noted that daily utilisation is highly variable, with utilisation on some days as low as 16% and other 98% (close to fully utilised).

20


EPCS utilisation by sex(Nov 2014 – Dec 2016)

EPCS utilisation % by sex and age group(Nov 2014 – Dec 2016)

Demographic breakdown of IHL and QHS referrals

Analysis of EPCS activity data shows that children and working age adults tend to use the service the most

8386, 48%

9080, 40%

2249, 44%

2629, 37%

5875, 33%

9409, 41%

2097, 41%

3370, 47%

3367, 19%

4244, 19%

818, 16%

1119, 16%

0% 20% 40% 60% 80% 100%

IHL_male

IHL_female

QHS_male

QHS_female

0 to 24 25 to 49 50 and above

• On average, women use the EPCS more than men, 57% of all referred patients are women.

• For both IHL and QHS, EPCS utilisation is concentrated amongst those between the age 0 to 24 and 25 to 49.

• A more detailed breakdown of activity by age band is presented on the following slide for both QHS and IHL.

22792

29851

Male Female

21


IHL utilisation by sex and age group(Nov 2014 – Dec 2016)

QHS utilisation by sex and age group*

Demographic breakdown of IHL and QHS referrals

0 2000 4000 6000 8000 10000

0 to 4

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 tp 79

80 and above

Male Female

0 500 1000 1500 2000 2500

0 to 4

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 tp 79

80 and above

Male Female

*Time period for QHS data to be confirmed

22


QHS EPCS utilisation per 1,000 patients(Apr 2015 – Nov 2016)

Practice level utilisation per 1,000 patients

There is variation across practices in terms of EPCS utilisation

• The graphs below show that there is variation in the relative level of utilisation of the EPCS across practices.

Note: St James’ Church Surgery is an outlier because since 11 July 2016, the clinic has closed and all its services have been transferred to QHS EPCS centre at Bermondsey Spa.

Utilisation level per 1000 patients is found by normalising average monthly utilisation by the list size for each practice.

IHL EPCS utilisation per 1,000 patients(Nov 2014 – Dec 2016)

0 20 40

Borough Medical Centre (Dr Sharma)

Blackfriars Medical Practice

Maddock Way Surgery

Borough Medical Centre (Dr Misra)

Falmouth Road 25 Group Practice

Aylesbury Medical Centre

East Street Surgery

Old Kent Road Surgery

Sir John Kirk Close Surgery

Trafalgar Surgery

Penrose Surgery

Villa Street Medical Centre

New Mill Street Surgery

Avicenna Health Centre

Bermondsey and Lansdowne Medical…

Manor Place Surgery

Park Medical Centre

Princess Street Group Practice

Albion Street Group Practice

Silverlock Medical Centre

Bermondsey Spa Medical Practice

Surrey Docks Health Centre

Grange Road Practice

St James' Church Surgery

0 5 10 15 20 25

Melbourne Grove Medical Practice

306 Medical Centre

The Lordship Lane Surgery

Dmc Healthcare Chadwick Road

The Nunhead Surgery

Lister Health Centre

Elm Lodge Surgery

The Hambledon Clinic

Dr P Arumugaraasah's Practice

Concordia Parkside

Acorn Surgery

The Dulwich Medical Centre

Sternhall Lane Surgery

Queens Road Phs Practice

Forest Hill Group Practice

Dr Rs Durston's Practice

St Giles Surgery

The Gardens Surgery

Lister Primary Care Centre

23


IHL EPCS average monthly appointments and excess capacity(Jan– Dec 2016)

IHL: Daily utilisation% in 2016

• There are high daily variations in EPCS utilisation at the south hub (IHL). In 2016, utilisation ranged from 16% to 98%.

• The graph below shows that utilisation on weekends (in particular Sunday) is lower than the rest of the week.

332288 301 281 275

201

125

122

118 108 124 120

142

199

0

100

200

300

400

500

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

EPCS avg. monthly appointments Monthly average excess capacity

Average monthly appointments and spare capacity for IHL is presented in the graph below, broken down by day of the week

24


QHS average monthly available appointments (Jan 2016 – Dec 2016)

QHS average monthly available appointments

Average available appointments for QHS, broken down by day of week are presented in the graph below

Note: Daily utilisation figures for QHS are not available

254 251

295

247230

250

198

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

25


Total prescribed items from Southwark CCG(Aug 2015 - Aug 2016)

Total prescribed items from the EPCS (Aug 2015 - Aug 2016)

Prescription mix

Prescribing data is used as a proxy for case-mix across the two EPCS hubs

0 500 1000 1500

Incontinence appliances

Other Drugs And Preparations

Anaesthesia

Stoma appliances

Malignant Disease &…

Dressings

Ear, Nose And Oropharynx

Immunological Products &…

Eye

Appliances

Obstetrics,Gynae+Urinary…

Musculoskeletal & Joint…

Infections

Skin

Respiratory System

Nutrition And Blood

Gastro-Intestinal System

Endocrine System

Central Nervous System

Cardiovascular System

Thousands

0 2 4 6 8

Immunological Products &…

Malignant Disease &…

Anaesthesia

Other Drugs And Preparations

Dressings

Cardiovascular System

Obstetrics,Gynae+Urinary…

Nutrition And Blood

Endocrine System

Eye

Gastro-Intestinal System

Appliances

Ear, Nose And Oropharynx

Musculoskeletal & Joint…

Respiratory System

Skin

Central Nervous System

Infections

Thousands

• Prescribing data indicates the majority of prescribed items relate to one-off, urgent treatments (such as infections and skin issues), while for the CCG as a whole, prescribed items relate to more long-term, complex conditions (such as cardiovascular system illnesses).

This is an internal document which provides confidential advice and guidance to partners and staff of Deloitte LLP and its subsidiaries. It is not to be copied or made available to any other party.

© 2017 Deloitte LLP. All rights reserved.

extended primary care service evaluation ... - southwark ccg · southwark • access to patient...

Documents