closing the gap between primary &

secondary care

Bridget Fletcher, Chief Executive, Airedale NHS FT

Richard Pope, Hon Consultant Physician, Airedale NHS FT

Colin Renwick, Chair, Airedale Wharfedale and Craven CCG

Is there a Gap between primary and secondary care?

Gap…what gap?Is there a gap between primary & secondary care?

Through their eyes…

“… I saw 3 different doctors in as many weeks and had to retell my story each time…”

“…communicate with everyone who supports me…”“…the systems work for systems not for individuals…”

“…catch me on a low day and support me…”“…no one asked me what was important to me…”

“…clinical priorities may not be my priorities

“…I don’t want to wait for a doctors appointment , I want to talk to someone immediately…”

“…need some way of checking where my prescription is and tracking its progress…”

“…have to keep repeating my story…”

stressed clinical staff

The need for changeThe need for change is compelling – the standard drivers include….

cost: an estimated 20% of healthcare spend is wasted on overuse,

misuse or underuse of care 72% of discretionary spend is controlled by the Doctor’s pen unprecedented efficiency challenges

The need for changeThe need for change is compelling – the standard drivers include….

complexity:

multimorbidity, including cognitive impairment, has become the “norm”

demand, particularly in the LTC area, is increasing rapidly

The need for change

The need for change is compelling – the standard drivers include….

quality:

the delivery models of the past are in many cases no longer fit for purpose measurement of quality is by silo – not really by users’ experience

The need for change

inertia:

failure to recognise these issues underpins much of the “aversion to change” in the NHS

close - or FILL - the gap?

Our Vision

The guiding principle of our shared vision

“ whilst commissioners and providers are responsible for whole populations, it will be our shared focus on meeting individual need that will define us.

This individual focus lies at the very heart of the delivery of ‘Right Care’….”

The dialogueLocally – series of very constructive meetings Primary:Secondary care

Enthusiasm

Sense of urgency and ability to move

Key element – Shared EHR as a tool for transformationgenerate the win:win

e-discharge

e-prescribing

MSK pathways across org boundaries

GUMCommunity services…..

Is this enough?

….the ‘aggregation of marginal gains’. Put simply….how small improvements in a number of different aspects of what we do can have a huge impact to the overall performance….

e-Consultation use May 2010 to March 2013 - Bradford , Dr J Connolly

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in primary care

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The guiding principle of our shared vision

“ whilst commissioners and providers are responsible for whole populations, it will be our shared focus on meeting individual need that will define us.

This individual focus lies at the very heart of the delivery of ‘Right Care’….”

how will we know what people

want/need – unless they tell us…

The person orchestrating their own care with clinicians working by exception

Closing the gap: where to start?

Need to secure GP and consultant confidence in the benefits of collaboration

A clear articulation of what the benefits (and risks) of collaboration are?

Mutual understanding and respect on both ‘sides’

Focus on what is (should be!) of importance to clinicians:

- getting the best clinical outcomes for our patients (no brainer)- getting the best value-based healthcare / use of resource in AWC)

Closing the gap: where to startChanging behaviours – taking responsibility for system resource – an OD Piece:

Hospital – ‘do I really need to admit’ – do I know what’s available in primary care

can I be bothered to pick up the ‘phone (use

SystmOne!!) to discuss with my primary care partner

GP – ‘do I really need to refer’ – could I use an alternative – can I

be bothered to spend

the time finding that alternative”

Clinical service collaboration ‘gap’ interface

AWC Federations /

practices

Delivering primary care

Interface (gap) opportunities:

MusculoskeletalGenitourinary medicineSubstance misuseCommunity servicesWhat else?

ANHSFT

Delivering secondary

care

Our shared Right Care STRATEGIC AIM: to blur the care delivery boundaries further and this gap to narrow?

Patient experience across AWC becomes SEAMLESS

Filling the Gap: Health Economy Clinical Boards

Membership: GPs/Consultants/Public Health Physicians/Lay

Focus on high impact / high spend (PHE data) / quality issues

Each Board co-designs / agree pathways and resource utilisation

?Cancer services?LTC / multi-morbidity?Vascular (CVS/Stroke/DM)

Core outputs: Patient Experience & evidence of QI

Filling the GapWhat does this mean?

Hospital staff in primary care and vice versa. Locally designed and owned approaches

Rich Clinical Data will facilitate better clinical decision making

There must be (effectively) a “single” patient record

Our Patients will make a huge contribution to the signalling that triggers response from the system

Filling the GapWhat does this mean?

Technology, not transport, will bring teams together

Pathways will be compressed.

This will decrease, not increase, work in the system

Clinicians’ working day will look very different

Our Patients will have a (much) better experience of care

Costs of care delivery, particularly for LTCs, will reduce

Filling the Gap continued

In order to work at real scale

What will the organisational forms look like ?

What will commissioning look like?

What will payment systems need to look like?