Upload File

national primary care conference · •gp availability well always need gps …. but doing proper...

  • Home
  • Documents
  • National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better
21
National Primary Care Conference Sustainable Primary Care & New Models: Healthy Prestatyn Iach Dr Chris Stockport

Upload: others

Post on 26-Sep-2020

1 views

Category:

Documents


0 download

Report

TRANSCRIPT

Page 1: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

National Primary Care ConferenceSustainable Primary Care & New Models: Healthy Prestatyn IachDr Chris Stockport

Page 2: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

Background• Currently ~22,000 patients in Prestatyn area

• Went live in April 2016 following contract resignations

• Decision to run as a Health Board directly managed practice

• Departure from traditional model to an MDT based model, with an emphasis on a ‘social model of care’

• Another ~50,000 patients in BCU run practices, and at varying points of implementing locally-tuned versions

Page 3: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

General principles

• Prudent HealthcareUnderstand what this means – it’s not just for secondary care. It is fundamental for sustainable primary care.

Areas targeted so far have only scraped the surface.

Lots of what we’re doing is overly complex, overly medicalised and adds little discernible value to individuals.

Page 4: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

General principles

• Social Focus‘Medicalise only when necessary.’

Social and lifestyle-related problems are often best managed with social and lifestyle-related solutions.

Page 5: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

General principles

• Risk & InnovationBeware of analysis paralysis

Be risk aware and not risk averse

Be honest about the ‘do nothing’ risks

Page 6: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

General principles

• Contractual basisLets not get distracted by all of this!

‘Directly Managed’ was the only option for Prestatyn.

ALL have advantages and disadvantages. Choose the best contract vehicle for local need.

Collaboration & sharing practice across contractual vehicles is key.

GMS

APMS

Health Board run

Page 7: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

General observations for the future

• GP availabilityWe’ll always need GPs

…. but doing proper ‘GP’ stuff.

There are plenty of other people working in Primary Care who are much better at dealing with some of the things I used to have to deal with.

Page 8: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

Prestatyn

• Common initial misperception was that the driver was GP shortage.

• In fact it created an opportunity with a large enough footing to be able to explore the practicalities of MDT working and model redesign

• Prestatyn was a ‘crisis’ we needed

Page 9: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

The HPI model

There are many influences, but three stand out:

• South Central Foundation, Alaska – NUKA

• Community Health Workers, Brazil

• Bromley by Bow, London

Page 10: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

The HPI model

Population split across 5 (MDT)‘KeyTeams’4 general teams + 1 housebound & care home teams

Page 11: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

The HPI model

Population split across 5 (MDT)‘KeyTeams’4 general teams + 1 housebound & care home teams

Page 12: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

The HPI model: KeyTeams

1.5 GP(s)

Complex medical stuff

Nurse Prac’s

O.T.

The‘demedicaliser’

Pharmacist

Coordinator

KeyTeams = multidisciplinary teams replacing the traditional GP role

per 6,000 pts

Page 13: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

The HPI model: KeyTeams

Supporting all of the teams:

Practice & Treatment Room Nursing

In-house Physio

Audiologist

Mental Health Practitioners

Research Team

Page 14: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

KeyTeam principles

• All team members have an equal contribution to make

• Stable team – professionals get to know how each other works, strengths, interests

• Co-located in one office for all of their admin rather than in ‘own’ consulting room

• Team members are around for advice or to discuss patients they are concerned about

Page 15: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better
Page 16: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

Learning, so far

Page 17: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

MDT glue

Learning, one year in:Non-clinical KeyTeam coordinators

Case holding

Incoming correspondence

Sign-posting

Form filling

Result filingProblem solving

Page 18: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

Learning, one year in:Non-clinical KeyTeam coordinators

• A definite winner!

• Already ….Estimated to have avoided 10,000 face to face appointments through signposting, or direct resolution of issue in the first year

Direct actioning and filing of 75%+ of incoming correspondence. Work ongoing looking at results

Case-holding complex patients

• Training programme created, with support from Bevan Commission

Page 19: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

Learning, one year in:Primary Care Occupational Therapists

Builds upon the NUKA ‘Behaviouralist’ role

Proving to be very successfulextremely well received by public

growing evidence of successful demedicalising

big growth in local partnerships and use of social prescribing

Further to go, including evolving the skill-mix

Page 20: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

Learning, one year in:MDT approach

Space, space, space.

GPs who were previously GMS partners take time to adjust (but can do) - but it takes time and support.

An evolved role for the GP – medical complexity, typically multi-morbidity. The easy stuff has been stripped away. This is not the same role as the traditional ‘salaried GP’ role.

Page 21: National Primary Care Conference · •GP availability Well always need GPs …. but doing proper GP stuff. There are plenty of other people working in Primary Care who are much better

Learning, one year in:Training costs

This isn’t just about GPs – we’re not training enough of ANY advanced practice professional to work in primary care.

Bringing experienced professionals out from secondary care can work, but they still need considerable on-the-job training to adapt and acclimatize.

Don’t underestimate the initial cost of this.


Increasing Physical Activity in Primary Care Andrew Murray GP and Scottish Government Increasing Physical Activity in Primary Care Andrew Murray GP and

Primary Care Access, Emergency Department Visits, and ... · according to patients’ reported ability to schedule GP appointments; from national GP Patient Survey data. GP consulting

Primary Care Mental Health Models of Care Economic ......The Primary Care Mental Health Alliance involves the GP Confederation, East London Foundation Trust, the Clinical Effectiveness

Assessment of the Lung in Primary Care - GP CME South/Sun_Plenary_0920 Spirometry gpcm… · Assessment of the Lung in Primary Care. ... Classification of COPD Severity ... Fixed

Primary Health Care: GP Services and Young People

Primary Care and GP and PCGP

GP Trainee Teaching Day 8th December 2010 Eating Disorders and Psychiatric Emergencies in Primary Care

Brief introduction to Primary Care (GP) SOAR users Last updated: 24 th August 2012

Managing heart failure in primary care: The GP perspective - IPCCS · 2018. 4. 11. · gencat.cat/ics Managing heart failure in primary care: The GP perspective Dr Miguel Angel Muñoz

Better Antenatal care case studies - GP CME South/Sat_Lounge2_1100_Paterson_Bett… · Better Antenatal care – case studies ... conversation between the primary care provider, the

GP Surveyors - Primary Care North Event

Digital-first primary care and practice payments · Case study: Digital-first Primary Care in London ..... 13 2 Specific proposals for amendments to GP ... development of digital

1 Addressing Nocturia in Primary Care Marco Blanker, MD PhD Academic GP & epidemiologist 1

WORKSHOP: 2.1. Primary care policy European Forum for Primary Care Pavol Štec, GP, PROMEDA s.r.o., Kežmarok, Slovak Republic Primary care and health of

List of GP Clinics Under Primary Care Network …...List of GP Clinics Under Primary Care Network (PCN) Scheme S/N Clinic Name Address Operating Hours (Please call the clinic to verify

Primary Care FIT FOR 20:20 GP Contract Seminar DUNCAN MILLER Programme Manager – More Scottish GP Contract

The Pharmacist in Primary Care An ... - University of Exeter€¦ · Campus, University of Exeter, Exeter EX1 2LU Dr Jo Butterworth, GP & In-Practice Fellow Primary Care Research

City and Hackney Teaching Primary Care Trust · Hackney. These included hospital, mental health, community and primary care services such as GP and dental care. We worked to ensure

Primary Medical Services (GP Practices)...Primary Medical Services (GP Practices) James Gleed Associate Director Commissioning Primary Care Delegated Commissioning The CCG took on

Dr Susan Taylor GP Remote and Rural Primary Care Morvern Medical Centre Loch line Morvern PA34 5UY Dr Susan Taylor GP Remote and Rural Primary Care Morvern

Primary Care Network · Primary Care Networks – making change happen Dr Chetal Sheth GP, Sarum North PCN Anna Morton Practice Manager, Sarum North PCN Alison Westmacott Director

GP Primary Batteries

QBE PRIMARY HEALTH & COMMUNITY CARE …...QBE PRIMARY HEALTH & COMMUNITY CARE ORGANISATIONS INSURANCE PROGRAM (PART A) ... additional general practice/GP clinic setting or an "After

GP & PHCRED Conference July 2005 Australian Primary Health Care Research Institute Nicholas Glasgow

NHS Unlimited? Who runs our GP services - … Unlimited.pdf · 3 Introduction The Companies in Primary Care Companies that have become involved in the primary care market are often

Haringey Primary Care Strategy Investment Plan 2013/14 1. … › Downloads › Board Papers... · 2013-07-18 · Extended Primary Health Care Teams attached to the GP networks providing

Benzodiazepine Prescribing in Primary Care Jeff Rudman Benzodiazepine Prescribing in Primary Care Newton Rigg Jan 2008 Jeff Rudman Cumbria PCT GP Prescribing

Telehealth: benefits for primary care Shahid Ali GP & National Clinical Lead Commissioning intelligence Clinical Lead Primary Care NHS Yorkshire and Humber

Primary Care FIT FOR 20:20 GP Contract – what next? Primary Care Division Scottish Government

GP 4001 Lecture Series 2006-2007 3. Dealing with undifferentiated problems in primary care II

Psychological Approaches in Primary Care Dr Andrew Wilson Bradford GP VTS

Increasing Physical Activity in Primary Care Andrew Murray GP and Scottish Government

Primary Care Physicians-Distribution and Population to ......Wisconsin’AHEC’Health’Workforce’Data’Brief! primary!care! physicians! primary!care ! ! ! ! ! ! !!!!! Primary!care!physicians!!

Community Health & Social Care Directorate …...Community Health & Social Care Directorate Primary Care Division Addresses Policy Enquiries to: For Action GP Practices Chief Executives

MIGRAINE IN PRIMARY CARE ADVISORS Implications of the new GP contract to headache management