dr paul twomey partnership council nov 2013 primary care opportunities set in the context of...
TRANSCRIPT
Dr Paul Twomey
Partnership Council Nov 2013
Primary Care Opportunities Set In the Context ofReconfiguration
OVERVIEW
•New System:CommissioningDevelopment / SustainabilityQA / Performance Management
HOW DO WE ?
•Focus GP Practice
GP PRACTICE Challenges / Opportunities / Threats
Strategic Reviews:
•Shift secondary Community
•7 / 7 and 8 to 8 Working• > Scrutiny (keogh + CQC)
•Issues re recruitment + moral
GP PRACTICE Challenges / Opportunities / Threats
‘WE’ NEED:
•Consistent quality primary care:for patients - focus primary care experienceFor system to evolve - reconfiguration
- effective utilisation + release of resources
GP PRACTICE Challenges / Opportunities / Threats
HOWEVER
•Essential to describe ‘What is Consistent Quality Primary Care’
•Headroom to enable and deliver change
•Super-saturated Sponge
Standard operating policies and procedures for primary care
Primary medical services assurance framework
UTILISING A DIFFERENT ENVIRONMENTPrimary Care Focus Area Team
CCG Executive
GPPractice
Primary Care Professional
GP Practice
as a Provider
PRIMARY CARE STRATEGY
• Office GP Practice
• Full range of primary care services through the working day
• Collaborative approach (federal model/other providers).
11
RESPONSIBLE OFFICER FUNCTION
To make available to their constituent doctors a quality assured Appraisal programme which is Fit for Purpose.
Supported by the Clinical Governance Framework which will provide suitable developmental opportunities
MEDICAL REVALIDATION
• First cycle 3 ¼ years
• ¼ Year 0 = 14 %
Residual cohort
• Year 1 - 20 %
• Year 2 - 40 %
• Year 3 - 40%
• Focus: Fitness for Practise vs Fitness for Purpose
Total Recommendations 177 (14%)
North Yorkshire 67 (10%)
Humber 104 (27 - 10%)
Deferments 4 4
GMC Actions 2 2
Reflections
INFORMATION FOR GP PRACTICE
GP HIGH LEVEL INDICATORS
• Secondary Care Activity
• QoF
• Prevalence LTC
• Exception Rate
• Prevention / Immunisations
• Medicines Management
• Patient Experience
OUTCOME STANDARDS 27
• Ca Management • AF Management
- Common Ca- Survival Rates 1 year - Prevalence- Emergency Admission
• Smoking Management
• Childhood Immunisation < 2 yrs • LTC Management
• Flu > 65 years
• Patient experience
- Prevalence- Admission rates- Some key QoF indicators
CLINICAL GOVERNANCE FRAMEWORK
CHARACTERISTICS OF QUALITY GENERAL PRACTICE • Holistic and evidence based approach to patient care• Continuity of care• Positive GP practice : patient relationship• Appropriate management of risk• Attention to detail• Good communication with patients and other health care
professionals• Appropriate skill mix• Education• Strong leadership• Support from secondary care colleagues• Quality IT support
Delivered by culture and system
HOW CAN WE CULTIVATE HIGH QUALITY PRIMARY CARE?
•Nurture current resources to build on strengths
•Promote new growth
•Consider hybrids
•Pruning
•Commissioning and design
NEXT STEPS ?
SYSTEMS FOR QUALITY GP PRACTICE• The Team
induction (int / ext) mentoringintegrated training programmeindividual team PDP well-beingskill mixcommunicationguidance
SYSTEMS FOR QUALITY GP PRACTICE• Service Delivery
8 am – 6.30 pmMonday Friday
access to whole team as clinically requiredfocus patient Objectivessupported by MDTs / complex case managementseamless relationship with community services
SYSTEMS FOR QUALITY GP PRACTICE
• Collaboration (spectrum)
• Focus primary care centre well-being service delivery capacity
• Bring / share enable• Build on good characteristics• Achieve 3 Rs
ACTION PLAN • Focus on what we value GP practice to deliver
(call to action)Health & Wellbeing Boards describe & supportPublic Health consistent good GP practice
•Bring / share to enableback office and clerical staff
•Medical Leadership
Focus Primary Care Centre
ACTION PLAN SUMMARY
COMMISSIONING OF GP PRACTICE
• Synergy of :
Core + (Area Team) = 9 clinical sessionsLocal enhanced services (HWBB)Resource identified from reconfiguration
ACTION PLAN SUMMARY
GOVERNANCE
3 steps:
•Conversation engagement sign off (AT)
ownership delivery
(CCG led) - local community•Consensus
•(AT / CCG /
Link / HWBB)
ACTION PLAN SUMMARY
KEY ACTIONS
• Consistent quality GP practice
NOWMonday - Friday 8.00 am – 6.30 pm
Integrated into wider community service
transparent
patient sees single service
SOON7 / 7 8 am – 8 pm build on characteristics of good GP practice
COMMISSIONING
• Minimise safety netting
• Utilise ITF (protection of PMS)
SERVICE DELIVERY
Timescalesre impact
• Unplanned admissions
Timely Discharge NOW
• LTCs 2 – 5 yrs
• Well-being 5 – 10 yrs
RECRUITMENT / RETENTION
• ACT NOW
change environment / culture well-being > relationship with Med Students and Drs in training
Year 4 5 yr sliding programme (training + Collab) Last 5 years Initial focus GPs but then broaden