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?
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