dr jack nagle, ceo, alpha healthcare
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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
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