getting the balance right kings fund 13 july 2011 fiona sim
TRANSCRIPT
Getting the balance right Kings Fund 13 July 2011
Fiona Sim
The juxtaposition of population health and general practice
The relevance of local population needs to GPs
Factors that may influence engagement Building capacity for population orientation Some conclusions
Clinician Advocate Director of SME = Businessman/woman Team leader Commissioner
GMP (GMC 2006): “All patients are entitled to care and treatment to meet their clinical needs”
Tomorrow’s Doctors (GMC 2009): “You must...Protect and promote the health of patients and the public”; and
“Demonstrate awareness of the clinical responsibilities and role of the doctor, making the care of the patient the first concern”; and
“Understand and accept the legal, moral and ethical responsibilities involved in protecting and promoting the health of individual patients, their dependants and the public”
‘Sufficient understanding of the structure, functions and behaviour of healthy and sick persons, as well as relations between the state of health and physical and social surroundings of the human being.’
Ref: EU Directive 2005/36, Article 24
The epidemiology of problems presenting in primary care
The risk factors for disease including alcohol and substance abuse, accidents, child abuse, diet, exercise,
genetics, occupation, social deprivation and sexual behaviour
The principles of prevention and preventative strategies
Demonstrate skills to change patients’ behaviour in health promotion and disease prevention
Community orientation An holistic approachRef: RCGP 2010 Access at: http://www.rcgp-curriculum.org.uk/rcgp_-
_gp_curriculum_documents/gp_curriculum_statements.aspx
GP as clinician and commissioner
Good GP, good health outcomes
Holistic, patient centred = upstream health promoting approach
Family or community orientation, social model
GP or Commissioner for population health ?
Inverse care law prevails [& not helped by Health Premium]
Disease orientation = minimal scope for health promotion
Solely reactive, medical model
Health improvement, promotionHealth protection Influencing access and quality of health & social care services
Quality of health care provisionPrimary careSecondary care to which we refer
Access to health carePrimary careSecondary care
Health care – and social care - of individual patients and the practice population
Health of the practice population
Practice population, but focus on individuals With few exceptions, little relevant training in
public health Awareness of importance of public health at high
level – health inequalities, communicable diseases - “Everyone’s business”
Less awareness of public health operational role in health care, beyond communicable disease control
Pressure from contract including QOF – 2ary prevention; long term conditions [LTC]
Pressure from QIPP agenda – increasing efficiency with quality
GPs are often described as “Hard to reach” Understanding the context of work and
remuneration Need to view GPs as members of clinical
commissioning groups (formerly GP Consortia) and GPs as clinicians and advocates for their registered population
Awareness of deterrents and incentives to engagement
Local Service Redesign - Long term conditions –involving management and GPs:
Diabetes COPD CVD/Health Checks
Intentions: Higher prevalence of good clinical practice Better health outcomes Reducing unplanned/avoidable admissions Reduced costs to whole health system - QIPP
GPs are often an untapped source of knowledge about local health needs
JSNA [Joint Strategic Needs Assessment] will be a document/range of products shared between commissioning groups, the local authority and key players such as community organisations and service providers that lie within a local authority area, and service users
‘Quality assessment of local communities’ health needs and assets is essential for effective and efficient commissioning of NHS and local authority services’ – NHS Confed 2011
To help identify and translate local priorities into action Outputs of JSNAs of use to GPs in commissioning
include population-level data for GPs, a priority-setting matrix and mapping the flow of money spent on priorities
JSNA upstream modelling tool – an exampleGateshead – the JSNA team uses information from a wide range of sources to map the flow of money spent on key priorities, such as mental health, circulatory disease and musculoskeletal conditions, to help support upstream investments
Ref: JSNA: a vital tool to aid commissioning, 2011; access at: http://www.rsph.org.uk/en/about-us/policy-and-projects/projects/the-role-of-the-joint-strategic-needs-assessment---national-briefing-and-training-support.cfm
Teaching public health through clinical medicine – undergraduate and postgraduate:To ensure appreciation of the social, economic, genetic, environmental, ethnic, cultural determinants/risk factors of health and, perhaps more importantly for clinicians, of disease
To understand prevalence and the impact of major risk factors on prevalence, care and management, as well as preventive strategies
Egs: RCP initiative – www.rcp.org.ukTPHNs materials –
http://www.healthknowledge.org.uk/teaching/teaching-public-health-action
GP commissioners need to be seen to be making objective decisions while continuing to work as GPs and this requires the population perspective
BMA report on Public Health Support to Clinical (GP) Commissioning explains why GP commissioners need Public Health specialist capacity - focus is on commissioning clinical care pathways, rather than health improvement
http://www.bma.org.uk/images/whitepaperpublichealthsupportdec2010_tcm41-202541.pdf
Traditional medical model distant from population perspective
Current medical training beginning to recognise population health
Experienced GPs rarely trained in PH GP curriculum ahead of most clinical
specialties – so cautious optimism re new GPs Amongst the reforms, JSNA could be helpful –
subject to governance and accountability Need for new levers, drivers and incentives
