2nd National primary Care Conference

MPHC

14 November 2012

Primary Care Centre Stage – Better Outcomes

with Scarce Resources

Jack Nagle,

CEO, APC

Outline

• Case for Primary Care

• Delivery Solutions

– Mechanism

– Methods

– Example

© Alpha Healthcare Ltd, Confidential

Alpha Background

• Founded 2003 – Ireland & UK

• Models for Practice Management & Primary Care Centre

Development

• Gold Standard systems & methodologies for General

practice

• TQM – total quality management

• Worked in more that 100 + practices

• Developed primary care centres,

• Strategic partner of the NHS Alliance

• Compliance to Care Quality Commission regulations

© Alpha Healthcare Ltd, Confidential

Change is happening..

IMAGINE !

Imagine if every patient, who really needed a bed in hospital had a bed available,

Imagine if many more people could be effectively treated for chronic disease in their local communities,

Imagine if these two events were connected and

Cost LESS

For BETTER health outcomes

Imagine….

PRIMARY CARE

See case studies and info at www.primarycare.ie

Chronic Disease Management

– Over 25% of Irish population suffer from chronic diseases –

these chronic diseases account for 80% of all healthcare

costs,

– 18 Chronic diseases account for 80% of hospital based

expenditure – 10% for diabetes alone,

– CD accounts for 80% of GP consultations, 60% of hospital bed

days & 2/3rds of emergency medical admissions to hospitals

– Best practice for management of chronic diseases involves

intervening with the patient when they are unwell the 1st time –

this is known as CDM or chronic disease management

– CDM is the foundation of the most effective healthcare

systems in the world - Canada, Australia and New Zealand

Confidential

Quality & TQM ?

• Quality – is it going to really impact on general practice?

• A philosophy!

– Focus on the patient,

– Focus on preventing problems rather than having to fix them,

– Relentlessly eliminating waste and inefficiencies,

– Involving all staff,

– Benchmarking and sharing best practice,

– Monitoring and reviewing performance,

• Key Enabler for :

– Efficiency improvements

I

SERVICE DELIVERY

Approach ( UK):

Commissioning :

- Process by which the health needs of the local population are identified,

priorities for investment are set and appropriate services are purchased and

evaluated

- National and Local incentives to promote

Provider:

- A health care provider is a legal entity, or a sub-set of a legal entity, which

may provide healthcare under NHS Service Agreements

- GP practice, NHS trust, Independent provider provider organisations

Competition:

- Efficiency & value for money ?

- Regulation – Standards & Quality

Care Quality Commission – UK

HIQA Standards for Primary Care ? CQC's Essential Quality & Safety Standards

Practices must meet these standards:

•OUTCOME 1: Regulation 15: Respecting & Involving people who use the services

•OUTCOME 2: Consent to care & treatmentInvolvement & Information

•OUTCOME 4: Care & welfare of people use use the services

•OUTCOME 5: Meeting nutritional needs

•OUTCOME 6: Co operating with other providers

Personalised Care Treatment & Support

•OUTCOME 7: Safeguarding people who use services from abuse

•OUTCOME 8: Cleanliness & Infection Control

•OUTCOME 9: Management of medicines

•OUTCOME 10: Safety & Suitability of premises•OUTCOME 11: Safety, availability and suitability of equipment

Safeguarding & Safety

•OUTCOME 12: Requirements relating to workers

•OUTCOME 13: Staffing

•OUTCOME 14: Supporting workers

Suitability of staffing & Suitability of Management

•OUTCOME 16: Assessing & monitoring the quality of service provision

•OUTCOME 17: Complaints

•OUTCOME 21: RecordsQuality & Management

Case Study :

TQM to Increase Practice Capacity

• Initial Consultation Rate = 8.17;

• After changes = 6.41

• 22% Improvement!

ISO 9001 2008

Case Study - NHS HEALTHCHECKS

Aim:

• Deliver cardio-vascular risk assessment to the eligible population within 5 years

• Assess 20% pa,

• Within general practice – reduce variability in levels of delivery,

Approach:

• Local Enhanced Service to encourage practice involvement,

• Improved patient care,

• Invite patients & do detailed health check risk assessment

• Communicate risk to patients & treat,

• Management in line with National Best Practice & NICE Guidance

• Payment to practices based on outcomes

ISO 9001 2008

Case Study - NHS HEALTHCHECKS

Goals for NHS Health checks at Medical Practice

• Suggestions from feedback session:

• Phase 1 3 sessions/wk -> 6 sessions w/k 75 a month -> 150 month

• Phase 2 6 sessions/wk -> 12 sessions wk 150 a month -> 300 month

• Value of Smoking Cessation -> NHS Health check

• Some patients for better Health Check

• Use some time from Better Health Clinics to NHS Health check

• Other “opportunistic” time to do NHS Health check

• Temporary capacity available from Diabetic Clinic

• Dressings – takes dedicated nurse time

• Travel Vaccination Time – seasonal (some time availability)

• Possibility of HCA doing NHS Health checks

ISO 9001 2008

Case Study - NHS HEALTHCHECKS

Macro Overview of Current Nursing Activity

Practice Nurse

Clinics 10 /week

Baby

Immunisations

1.5/week

NHS Healthcheck

3/week

Diabetic

3/week

Admin

2 session/ week

Healthcare

Assistant

16/week

Coils & Minor

Surgery

2 session /week

Better Health

12/week

Nurse Practce

4/week

Well Women

5/week

Travel Clinic

1/weekPractice Nurse

Messages

1/2 session/ week

Smoking

15/wk

ISO 9001 2008

Case Study - NHS HEALTHCHECKS

NHS HEALTHCHECKS - MONTHLY LEVELS

0

20

40

60

80

100

120

140

160

Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12

N

o

P

e

r

M

o

n

t

h

Total

Male

Female

Recap

• Significant change happening within healthcare,

• Primary Care – opportunities

• “More from less” through TQM!

Q & A