The Polyclinic Service ModelDr Miguel Godfrey HUDU: Can Planning Deliver? Planning for Health and Social Infrastructure 14 May 2008

Change Is On The Way

“Sainsbury Doctor set up shop”– Guardian, 7 March

“Supermarkets to offer in-store GP” – BBC News, 25 February 2008

“Super-surgeries to go on trial in first steps towards Tesco-style franchises”

– Times, 17 December 2007

“It’s doc around the shop at Manchester store”

– HSJ, 06 March

London Commissioning Group

Clinical Advisory Group

HfL Programme Executive Group

All London PCT Boards

NHS LondonBoard

Patient and Public Advisory

Group

Joint Committee of PCTs

Joint Overview and Scrutiny Committee

Stroke Major Trauma Polyclinics

Local Hospital

Feasibility

Unscheduled care

Mental Health

Services

Children’s Services

HfL Public Consultation

Healthcare for London ProjectsNext Stage

Review Clinical Working Groups

Governance for HfL Consultation

Accountable

Reporting

Advising

Scrutinising

Long term conditions (Diabetes)

Governance structure for Healthcare for London

Polyclinic?

“Ignore the doctors polyclinics are the future”

“Boris at odds with Ken over plan for NHS polyclinic”

“Last chance to save your GP”

“Polyclinics mean different things to different people”

- Public Finance and Accounting

The Polyclinic Project

• Heather O’Meara – SRO, CEO Redbridge PCT

• Tom Coffey – Clinical Director, GP Wandsworth PCT

• Deborah Colvin – Clinical Lead, GP City & Hackney PCT

• Marilyn Plant – Clinical Lead, GP Richmond & Twickenham PCT

• Christina Craig – Project Manager, Healthcare for London

• Project Team – Jennie Bostock (Senior Project Officer), Sophie Coronini-Cronberg (Project Officer) Vanessa Leyton (Project Administrator), and Miguel Godfrey (Project Policy Manager)

The Polyclinic Service Model

‘A Framework for Action’ set the need to develop a new model of community based care at a level that falls between the current GP practice and the traditional District General Hospital. It sets out:

• the services that could be provided

• the hours the services could be available

• the different types of organisational model

• to be clear that the concept is flexible and the design and localities of each polyclinic would need to meet the needs of each community

Principles of the Polyclinic Service Model

• Meeting individual needs and improving choice – this means giving patients control of how, when and where their health and social needs are met.

• Regionalising services where necessary - this is about bringing services closer to the patient wherever possible s and giving them access to excellent specialist care.

• Integrating care and partnership working - this means making healthcare and social care joined-up to promote the individual’s general wellbeing.

• Prevention is better than cure – actively promoting individuals’ physical and mental wellbeing and helping them to stay healthy.

• Equality of health healthcare accessibility – this is about giving everybody access to the best possible health and social care but particularly helping those facing the most inequality of care.

Polyclinic Service ModelA polyclinic development programme is……to gather information and explore issues on how the polyclinic services model could work…encourage very wide range of pilots…pilot for three months…co-develop with PCT the local interpretation of polyclinic

A polyclinic development programme is not……predetermined it will be shaped by consultation…a building there is no one size fits all solution to a commissioned service model

PCT commissioners commit to exploring…

…the range of services in a polyclinic

…the organizational models and locations

…commissioning within the competition framework

…the enablers: Workforce, IT and transport etc.

Polyclinic

Setting out the servicesGP:

o GP Services- Consulting and procedure rooms- Dedicated child-friendly facilities - Core and extended GP services- Extended hours 8AM-8PM

o Practice Nurse services

Pharmacyo Medicines use reviewo Medicines management serviceso Anti-coagulation serviceso Dispensing serviceso Available 18 – 24 hours

Community Services:o District Nursingo Health visitors & children’s serviceso Midwiferyo Specialised therapieso Outreach services (TB/HIV)o End-of-life careo Dieticianso Available 12 hours

Other Healthcare Professionals:o Opticiano Dentisto Other health professionalo Available 12 hours

Interactive Health Information Services:o Smoking cessationo Drug and alcohol information serviceso Weight managemento Sexual healtho Dietary serviceso Local services (e.g. social services, back to work services, and leisure facilities)o Healthy living classeso Available 18 – 24 hours

Minor procedures:o Phlebotomyo IUCDo Suture removalo Joint injectionso Minor surgical procedureso Joint injectionso Available 12 hours

Outpatient Services:o Management of chronic illness (e.g. COPD, asthma and diabetes)o Community paediatricso Consultant or PwSo Mental healtho Audiologyo Chemotherapyo IV transfusionso Access to pain managemento Available 12 hours

Urgent Care:o Minor injuries unito Walk-in centreo Urgent care centreo Available out of hours

Long Term Conditions:o Detection of undiagnosedo Screening & early detectiono Community matronso Management of disease registerso Access to- Expert patient programme- Information prescriptions- Managers of complex needs

oAvailable 12 hours

Diagnostics:o ECG, Pulse Oximetry, Spirometryo X-ray, U/S and Vascular Dopplero CTGo CT, MRIo Colonoscopyo Haematology, microbiology and pathologyo Available 18 – 24 hours

Organisational Models

DIFFERENT TYPES OF POLYCLINIC

A NETWORKED POLYCLINIC SAME-SITE POLYCLINIC HOSPITAL POLYCLINIC

Existing GP practices would link to a local ‘hub’ for specialist clinics and services such as blood tests, scanning and plaster facilities. The ‘hub’ could be developed from an existing GP practice or other provider or a new building

GP practices could come together under one roof, sharing many services but being run as different practices, perhaps linkingwith some other practices

GPs could merge into one large practice, again linking with other practices which are not on the same site.

Based at the `front door’ of local hospitals. These would be led by GPs and other healthcare professionals experienced in working in the community and they would provide the local population with the same range of services and staff as other polyclinics but be open 24/7.

Polyclinic Development Programme Workshops

Workshop 1

Introductionand Services

1st May

Workshop 2

The Key Enablers

21st May

Workshop 3

Organisational Models

w/c 9th June

Workshop 5

Key Learning & Next Steps

w/c 7th July

Workshop 4

Commissioning

w/c 23rd June

•Introduction•The Service Model•Services•Case studies•Integrated patient care

•Identify Enablers•IT requirements•Workforce requirements•Training (needs & facilities)•Modelling access

•Organisational models •Location models•Advantages disadvantages•Governance arrangements•Enablers and constraints

•Options (pros & Cons)•Case studies•Key Enablers•Skills & Expertise

•Consolidate key learning•Outstanding issues

Development Workshops

Nearly 1 million trips/day are made in London to or from health services• This equates to almost 5% of all trips (as compared with, for example, 13%

of all trips being for education and 19.5% for shopping)• 51% of trips are made by car – as driver or passenger • 19% are walking trips, 14% are made by bus, 10% by tube and rail• There are around 1,600 GP practices in London • The average travel time to the nearest GP surgery for Londoners is around 8

minutes. For more than 80% of Londoners, the quickest way to access the nearest GP surgery is by walking

These figures emphasise the importance of local access by foot to health facilities and the important role of the car, and to a lesser degree public transport, in longer journeys.

Transport – Facts & Figures

CAPITAL

Public Transport Accessibility Index (PTAI / PTAL)

HfL COMMISSIONED

SERVICE TRAVEL MODEL

Master Model

Desktop Model

Travel network data (Public transport,

highway information, etc.)

CAPITAL

Health user data from NHS (service uses, demographic, etc)

Spatial and other key data sets (e.g. census)

MODEL OUTPUTS

Travel and other demographic impacts

Outputs of interest to the selection of pilot sites:

• intelligence on who would be disadvantaged by a choice of polyclinic location;

• intelligence on who would benefit from a choice of polyclinic location;

• effect of polyclinic site on changes in the average travel time for patients;

• effect of relocating primary (and some secondary) healthcare into a polyclinic on population dynamics – e.g. distribution of those with a greater or less than a cut-off percentage change in average travel time, identification of disproportionate negative impact in disadvantaged areas;

• effect of GP relocation to a polyclinic on average travel times;• effect of opening a polyclinic on public transport accessibility

(based on current usage and availability).• Allow for information to be updated at regular intervals

End

• Questions?