have your say on our plans for primary care in warrington
TRANSCRIPT
Have your say on our plans for Primary Care in
Warrington
Dr Andy Davies, Clinical Chief Officer
Why are we doing this?
What are we doing?NHS Warrington Clinical Commissioning group have drafted a strategy outlining our vision for
the future of Primary care in Warrington.
We want the views of members of the public, patients, Doctors, Nurses and other key
stakeholders on the changes we are proposing.
The Priorities
There are ten priorities identified in the
strategy…
Development of the strategyAccess, Demand and Capacity
Issue:• Demand is increasing• More complex cases
requiring a different type of response to traditional 10 minute appointment
• Shortages of staff and new types of staff with different skill mix
• Higher public expectations
Solution:• Provide services across Warrington and across
clusters to increase capacity and share expertise and resources
• New technology to provide services in a different way, e.g. telehealth and telemedicine
• More focus on preventative measures to reduce demand
• More focus on anticipatory and proactive care to prevent problems escalating and causing an increase in demand
Benefits:• Patients have better access to appropriate services when they need
them, including opportunity for different types of access such as telephone consultations, and evening and weekend appointments, more same day appointments
• Opportunity for longer appointments for more complex cases
Development of the strategyMedicines Management and Prescribing
Issue:• High spend on medicines
that if not all appropriate could be used to fund alternative services
• Potential poor outcomes due to polypharmacy (if on more than two medications)
Solution:• Medicines management integrated within
the multi disciplinary team made possible by cluster working
• Proactive holistic assessment including medicines review and management
• Risk satisfaction tool to identify patients who may benefit from review
Benefits:• Better patient outcomes by medicines review and improved
prescribing• Better use of resources by saving on prescribing costs that
can be used to fund other services
Development of the strategyCare Homes - Nursing and Residential
Issue:• Increasing older population• 1600 care home residents in
Warrington care homes• Care provided to these very
vulnerable patients is reactive and as a result is felt that there are admissions to hospital that could be avoided
• Inefficient use of GP time to visit multiple care homes to see individual patients
Solution:• Multidisciplinary team developed assigned to care homes
to take a proactive approach to care of residents• Undertake holistic assessment that anticipates problems
and avoids escalation that would require admission to hospital
• Regular contact with home improves skill level and confidence of care home staff to enable less reliance of primary care/Bridgewater care home team
• More effective use of GP time that can be utilised for other services
Benefits:• Better patient outcomes by holistic proactive assessment• More proactive care for early diagnosis and treatment• Reduced admissions to hospital and A&E• Reduced number of GP home visits• Improved continuity of care
Development of the strategyWhole System/Right Care
Issue:• High pressure on the
health system• Integration makes best
use of resources, better for patient, especially those with complex care needs
Solution:• Care co-ordinators available to offer single point of
contact• Different levels of care co-ordination being identified• Risk stratification tool to identify patients’ needs and
allow planning of appropriate services to meet their needs
• System integration – social and health care services organised around practice lists within clusters
Benefits:• More co-ordinated and joined up care for patients• More focus on non medical response• Increased patient independence• Improved patient outcomes• Reduced duplication of services and more effective use of available
resources
Development of the strategyComplex Care
(Including long term conditions and cancer rehab)
Issue:• Increase patients with long term
conditions• Complex care packages which are
provided by multiple agencies often in an uncoordinated way
• Care is often reactive with not enough focus on self care and proactive management to avoid escalation of patient’s condition
Solution:• More proactive care with greater focus on
self care and prevention• Care co-ordinators to support patients with
complex care packages• Different ways of assessment with
opportunity for longer, more in depth appointments / assessments
Benefits:• More co-ordinated and joined up care for patients• Improved patient outcomes• Patients more independent
Development of the strategyPromoting Prevention and Self-Care
Issue:• Unhealthy lifestyle
can cause ill health
Solution:• More scope for self management and prevention
services in clusters• Local health campaigns in every practice• Health check and health mentor referrals
Benefits:• Healthy lifestyle can prevent ill health• Less demand on primary care• Improved patient outcome
Development of the strategy
Mental Health
Issue:• Access can be difficult
• Need services close to the patient
Solution:To provide Improving Access to Psychological Therapies (IAPT) and outreach Community Psychiatric Nurse services within the cluster model
Benefits:• Improved local access• Improve overall care for patient
Development of the strategyWorkforce Development and Sustainability
Issue:• Warrington is currently under
doctored by 29 whole time equivalent GPs
• Hard to attract new GPs• Several GPs close to retirement• Other staff groups hard to recruit
e.g. nurses• Patient understanding of health
professionals role within primary care
Solution:• Opportunities for skill development, building expertise
and gaining experience via provision of service over bigger geographical area than single practice
• Closer working with secondary care to improve skills• Development of new roles and review of skill mix• Improve understanding of the role of other health
professionals i.e. practice nurse
Benefits:• Improved chance of attracting high quality staff• Improved work life balance for primary care staff to help with retention and
recruitment and improve quality of care• Improved quality of care• More efficient use of all primary care health professionals leading to
increased access
Development of the strategy
Last but not least…..
Public engagement and communications in primary careWe need to ensure that we build on what we do now and improve the way in which we engage with patients, the public, Doctors, Nurses and other key stakeholders so that we continue to take their views into account as we further develop our services.
The Warrington ‘brand’The Quality Standard for Primary Care
From 2015, with the changes around the commissioning responsibility for Primary Care, the CCG has had the
opportunity to closely influence the way in which Primary Care works. This ‘co-commissioning’ means a significant
move to more local commissioning of Primary Care.
This has given us the opportunity to look at what Primary Care looks like across Warrington and by working with local
GPs we have developed a Quality Standard for Primary Care… The Warrington ‘Brand’.
The Warrington ‘brand’In real terms
The Warrington ‘Brand' will address equality of service across Warrington, helping to ensure that
every registered patient has the same access to the same services in each GP practice.
It will also ensure there is a quality benchmark for all GP practices.
Challenges facing General Practice
Your GP surgery is the first point of contact for most people when they are unwell or need medical advice.
This presents a real challenge…as people are living longer with multiple long-term
conditions the pressure on Primary Care is increasing year on year and has seen unprecedented leap in the last decade.
This adds to the already significant financial challenge on health and social care.
• Since 2008 the workload in General Practice has increased by 40%
Whilst at the same time
• The growth in the number of people becoming a GP has fallen well behind other clinical professions (Between 2006 and 2013, GP numbers grew by just 4%)
More Demand + Less GPs = The need to work differently
General Practice The Challenge
Clusters – GPs working together
One of the proposals within the draft Primary Care strategy is around the idea of GP practices working in a cluster model with neighbouring practices, sharing some services and resources. This could mean that patients may access some health care services in other local locations as well as their usual practice.
This doesn’t mean your usual GP consultation, but maybe additional services e.g. extended GP hours, service for people with long term conditions
Next stepsThe draft Primary Care strategy and summary document are available to
view on the CCG website. http://www.warringtonccg.nhs.uk/get-involved/consultations_2.htm