NHS England conference on 7 day

openingNovember 2013

Dr Ivan Benett - Clinical Director, Central Manchester CCG

GPwSI in Cardiology & Care Clinical Champion for Healthier Together

NHS England conference on 7 day

openingNovember 2013

Dr Ivan Benett - Clinical Director, Central Manchester CCG

GPwSI in Cardiology & Care Clinical Champion for Healthier Together

Being open for business: 7 day opening in Primary Care

A Case Study

Need consistent high quality Primary Care to manage activity out of hospital

Wide variation in activity, outcomes & care pathways including primary prevention, self-management & patient education, and management of long term conditions

Inconsistent access & responsiveness to urgent care demand

Poor integration with Social care, Mental Health, and In-Hospital Care

Workforce capacity & capability gaps.

Potential for increased efficiency-e.g. prescribing & medicines optimisation, referrals, reduced admissions & readmissions

IT and Estates not fit for purpose

Primary Care is already at capacity with low morale

Primary Care Case for Change,Primary Care Case for Change,

Results of GP Survey 12-13

A&E activity for Central Manchester

A&E activity for Central Manchester

4/6 self refer to A&E. 1/6 is taken by the emergency services, 1/6 is sent by other health professionals,

Day of the week - most attendances are on Mondays and the numbers FALL as the week progresses.

Time of day - most demand starts at 9 am and falls off after 8pm. No case for extended Primary Care/GP access beyond 8pm.

Age of patient - 50% are less than 30 years old; one in 4-5 is less than 10 years old.

The Clinical ModelThe Clinical Model4 localities, each 50,000 population

1 hub practice per locality of 8-10 practices

EMIS Web

96 extra consultations

50 urgent/same day + 34 convenience – able to flex in the week

Booked in by other surgeries at first, but by A&E and OOHs eventually

Access StandardsAccess Standards

Responsiveness

Requests for same day consultations will be clinically triaged within 60 minutes. If considered urgent will be seen within 2 hours, or within 6 hours if considered requiring same day consultation. Calls requesting urgent advice will be clinically triaged within 20 minutes

Quality Premium (possible future QOF) for achieving 95% -Part payment for 85% achievement

AvailabilityPeople who are ill or have a long-term condition will have access to their own practice or a Primary Care practice in their locality 8am to 8pm on week days and for three hours on Saturday, Sunday.

Extra availability will be commissioned from Primary care provider outside normal surgery hours

THE PROVIDER

All 35 Central Manchester Practices signed up in principle

Allows for different degrees of opt-in to sharing services

CCG Clinical leadership formed a reference group of future GP leaders & managers to come up with solutions

How do we do this quickly & for the whole population?

CHALLENGES

• Practice buy in• IT & Estates• Workforce• Access to other NHS services• Publicity• Financial evaluation and sustainability• Supporting not destabilising the rest of the

system• Procurement and competition laws

Evaluation & Implementation -PDSA Cycles

Hunches Theories

Ideas

Changes That Result in Improvement

A P

S D

APS

D

A P

S D

D SP A

DATA

Very Small Scale Test

Follow-up Tests

Wide-Scale Tests of Change

Implementation of Change

Improvement Methodology

The FutureThe Future

Benefits & Outcomes• Reduces A&E attendances

• Better patient satisfaction

• More comprehensive management of people with long term conditions

• Better integration with in-hospital care and social care

• Fewer admissions to care homes & hospital by better proactive management

Developments• Booking in from A&E and OOHs

services

• Direct booking from patients

• Full Primary care service during extended availability

• GPwSI services & Secondary care follow ups in localities

• Better access to diagnostics

12

Thank you & any questions?