primary care – changing future 1 primis 23 rd april 2002 metropole birmingham
TRANSCRIPT
![Page 1: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/1.jpg)
1
P
rimar
y C
are
– C
hang
ing
Fut
ure
PRIMIS 23rd April 2002Metropole Birmingham
![Page 2: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/2.jpg)
2
Primary Care
The changing future
![Page 3: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/3.jpg)
3
P
rimar
y C
are
– C
hang
ing
Fut
ure
What will change?
• What we do
• Who we work with
• How we plan, develop and deliver services
![Page 4: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/4.jpg)
4
P
rimar
y C
are
– C
hang
ing
Fut
ure
What will change?
• What we do
• Who we work with
• How we plan, develop and deliver services
![Page 5: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/5.jpg)
5
P
rimar
y C
are
– C
hang
ing
Fut
ure
The Concept of MigrationV
olu
me o
f Activ
ity
Dista
nce
HomePracticeLocalityDGHSub Regional
RegionalSupra Regional
National PCT
![Page 6: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/6.jpg)
6
P
rimar
y C
are
– C
hang
ing
Fut
ure
What will change?
• What we do
• Who we work with
• How we plan, develop and deliver services
![Page 7: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/7.jpg)
7
P
rimar
y C
are
– C
hang
ing
Fut
ure
Partnerships
![Page 8: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/8.jpg)
8
P
rimar
y C
are
– C
hang
ing
Fut
ure
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
![Page 9: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/9.jpg)
9
P
rimar
y C
are
– C
hang
ing
Fut
ure
What will change?
• What we do
• Who we work with
• How we plan, develop and deliver services
![Page 10: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/10.jpg)
10
P
rimar
y C
are
– C
hang
ing
Fut
ure
KEY WORDS
Prio
rit y
Quality
Access
Equity
Demand
Supply
Modernisation
![Page 11: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/11.jpg)
11
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Met need
Unmet need
Service demand and capacity
![Page 12: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/12.jpg)
12
P
rimar
y C
are
– C
hang
ing
Fut
ure
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.
![Page 13: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/13.jpg)
13
P
rimar
y C
are
– C
hang
ing
Fut
ure
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.
![Page 14: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/14.jpg)
14
P
rimar
y C
are
– C
hang
ing
Fut
ure
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.
![Page 15: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/15.jpg)
15
P
rimar
y C
are
– C
hang
ing
Fut
ure
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.
![Page 16: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/16.jpg)
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
![Page 17: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/17.jpg)
17
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Met need
Unmet need
Adjusting referrals
![Page 18: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/18.jpg)
18
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Met need
Unmet need
Adjusting referralsWhole HA
0
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%
![Page 19: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/19.jpg)
19
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Met need
Adjusting referralsWhole HA
0
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
![Page 20: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/20.jpg)
20
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Adjusting referralsWhole HA
0
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
Met need
Met Filled
Protocol driven referrals
![Page 21: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/21.jpg)
21
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Met need
Unmet need
More than 10%imbalance
![Page 22: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/22.jpg)
22
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
![Page 23: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/23.jpg)
23
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
![Page 24: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/24.jpg)
24
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
![Page 25: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/25.jpg)
25
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
![Page 26: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/26.jpg)
26
P
rimar
y C
are
– C
hang
ing
Fut
ure
Unmet need Capacity filled
Must have secondary care
Could be done in primary care
Adjusting services
![Page 27: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/27.jpg)
27
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
![Page 28: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/28.jpg)
28
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
![Page 29: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/29.jpg)
29
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Must have secondary care
Could be done in primary care
Adjusting services
![Page 30: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/30.jpg)
30
P
rimar
y C
are
– C
hang
ing
Fut
ure
Demand Capacity
Could be done in primary care
Adjusting services
Must have secondary care
Protocol driven referrals
![Page 31: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/31.jpg)
orthop refs per 1000 ptnt
0
5
10
15
20
25
30
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
Practices anon
Act
ivit
y p
er
1000
pat
ien
ts
orthop refs per 1000 ptnt
![Page 32: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/32.jpg)
0
5
10
15
20
25
30
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
Additions to orthop IP list per 1000 ptnt referrals not listsed per 1000 ptnt
![Page 33: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/33.jpg)
% 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
![Page 34: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/34.jpg)
34
P
rimar
y C
are
– C
hang
ing
Fut
ure
Endoscopy services
![Page 35: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/35.jpg)
35
P
rimar
y C
are
– C
hang
ing
Fut
ure
• Nuffield access equates to high referrals
• Average gastroscopy activity is 5.4 per 1000 population
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
1 3 5 7 9 11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
Nuffield Annual rate per 1000 pop
SUHT Annual rate per 1000 pop
Activity rates - City PCT
![Page 36: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/36.jpg)
36
P
rimar
y C
are
– C
hang
ing
Fut
ure
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
![Page 37: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/37.jpg)
37
P
rimar
y C
are
– C
hang
ing
Fut
ure
• Nuffield access equates to high referrals
• Average gastroscopy activity is 5.4 per 1000 population
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
1 3 5 7 9 11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
Nuffield Annual rate per 1000 pop
SUHT Annual rate per 1000 pop
Activity rates - City PCT
Average
Expected
Expected increase
![Page 38: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/38.jpg)
38
P
rimar
y C
are
– C
hang
ing
Fut
ure
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
![Page 39: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/39.jpg)
39
P
rimar
y C
are
– C
hang
ing
Fut
ure
Primary care managing throughput
• Delayed discharges (5/95)• Managing care• Managing waiting lists
– Clinically– Comparatively
![Page 40: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/40.jpg)
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
![Page 41: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/41.jpg)
Reduced independence
Pre-intervention and reablementfunction
Primary Care
Secondary Care
INTERVENTION
Best independence
Reabling independence
Admission avoidance
![Page 42: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/42.jpg)
42
P
rimar
y C
are
– C
hang
ing
Fut
ure
Balance
• Between demand and capacity
• Between availability and need
• Between needs and wants
![Page 43: Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a029c5503464c588b4c7f/html5/thumbnails/43.jpg)
43
P
rimar
y C
are
– C
hang
ing
Fut
ure
PRIMIS
23rd April 2002Metropole Birmingham