mansel aylward presentation wspcr 2010
TRANSCRIPT
Public Health Institute
How the Public Health Wales Trust can help build the integration of services, teaching and research. Professor Sir Mansel Aylward CB Chair Public Health Wales
3rd November 2010
Public Health Institute
Public Health Institute: Conceptual Clarity • Research, policy,
practice in an iterative relationship
• Creating a space for dialogue and knowledge creation
• The art and science of making a difference
Knowledge Space
Policy
Practice
Research
Public Health Institute
Conceptual Clarity
• Research and development • Professional development • Multi disciplinary/ Multi sectoral • Focusing resources on the big
questions • Wales in the world
Public Health Institute
What are we trying to achieve?
• A healthier, happier and fairer Wales • Reduce premature mortality • “Life to years” as well as “years to life” • Reduce inequity/inequality Through… • Translating what we know works into practice • Scanning the horizon- taking the long term
view • Seeking “early wins”
Public Health Institute
Organisational Design
• A clear identity • Professionally driven but
stakeholder focussed • Networked model with a small
physical core
Public Health Institute
Moving Forward • Early progress is possible, building on
existing functions and relationships • Adopt an experimental pathfinder
approach- maternal and child health • Grow the concept around core functions
and solid delivery • Map existing networks and resources • Engage potential partners in dialogue
Public Health Institute
Moving Forward
• Work within existing structures e.g. NISHCR, Academic Health Sciences Collaboration
• Explore funding possibilities-MRC, ESRC, Lottery, Charities
Primary Care supporting Public Health
• Promoting health of the population – Patient empowerment; self management; – Promoting public health messages – Supporting Care in the community
• Improve safety and quality – Safe systems – Clinical effectiveness – Encourage appropriate and more efficient use of
primary & secondary care services • Primary care data
– Prevalence, activity, benchmarking – Audit & Feedback
Implementing Strategy
Nationally coordinated, locally delivered
National agendas need local expertise and data
Most of the population have contact with
their General practice every year
Public Health Wales & Primary Care
National organisation • Primary Care Quality and Information
Service • Primary Medical Care Advisory Team • 1000 lives plus • Evidence Based Sources • Observatory • Pharmaceutical Public Health
Welsh Backs AIM
To minimise the financial, personal, and psychosocial effects of mechanical low back pain in Wales by promoting the ‘stay active’ message
Strategic Approach • Consistent, clear and concise messages
• Identify appropriate resources
• An effective dissemination strategy
• Work with key stakeholders to deliver the strategy
• Monitor, evaluate, feed back
Appropriate Resources
The Back Book
WeMeReC bulletin
Interactive desk aid
0
10
20
30
40
50
60
70
80
90
100
%
Angle
sey
Bridg
end
Powy
sDe
nbigh
shire
Vale
of Gl
amorg
an
Monm
outh
Pemb
rokes
hire
Swan
sea
Caerp
hilly
Blae
nau G
went
Wrex
ham
All W
ales
Cardi
ffCa
rmart
hens
hire
Cered
igion
Neath
Port
Talb
otNe
wport RC
T
Flints
hire
Torfa
enCo
nwy
Merth
yr Ty
dfil
Gwyn
edd
Locality
% of Welsh Practices Ordering The Back Book (Nov 2007-Sept 2010)
WeMeReC Bulletin Case studies sent to
• 2,470 GPs • 2,900 pharmacists (first time participated)
Completed by • 688 GPs (28%)
247 paper copy and 441 on line • 103 pharmacists
Bulletin & copy of Back Book sent to • 2,470 GPs / 2,900 pharmacists
Outcomes
Change in GP behaviour – Significant increase in number of GPs giving the
stay active message – Decrease in number of GPs advising rest
Change in population health beliefs – Staying active with back pain – Not resting with back pain
Clear Messages • Work is generally good for people’s
health
• Early intervention is important to prevent long term worklessness
• For people with back pain ‘staying active’ usually means staying in work
• Addressing the psychosocial issues
Appropriate Resources
Healthy Working Wales website • E-learning • Desk aids • Downloadable leaflets / publications • ‘Ask the expert’ e-mail advice
Health and Work Advice Line The Back Book National Education Programme
• RCGP half-day accredited training
Effective Dissemination
RCGP Events 200 GPs
Mailing of information to signpost to resources (such as Back Book, signposting documents, WAMH in PC, online
resources, CPD session and RCGP events) 2000 GPs
Online resources (Deanery learning modules; WeMeReC
modules, HWW website) 600 GPs
CPD Sessions (350 GPs) &
practice visits (400 GPs)
750 GPs
Collaborative Working
• Welsh Assembly Government • Cardiff University • Postgraduate Deanery • Welsh Medicines Resource Centre • Royal College of General Practitioners • Institute of Rural Health • Health Boards • Harvard University and other international Universities • Department of Health (England) and Department for
Work and Pensions
Progress To Date
Back pain pathway agreed • Focuses on ‘stay active’ message • Includes advice on fitness to work
Back pain educational tool completed • Produced and promoted by the Deanery
WeMeReC module on management of depression Practice visits ongoing CPD and RCGP accredited events arranged
Primary Care Quality & Information Service (PCQIS) Assists Health Boards, practice teams and individual primary care practitioners to improve the quality of the care that they deliver by:
• Providing access to evidence-based quality improvement guidance and tools • Encouraging review, reflection and revision
PCQIS Supporting Health Boards
NHS Wales Annual Operating Framework 2010/11
• Improving patient care in the community
• Chronic Conditions Management • Primary Care Services • 1000 lives Plus Programme • Health Care Associated Infections
PCQIS & 1000 Lives Plus Programme LHBs will be required
• To set appropriate local targets for the reduction of harm
• To demonstrate participation and sign up to coding of clinical data, process of data entry and sign up to mini-collaborative – Anticoagulation Monitoring
– Chronic Heart Failure (Wrexham project) – Reducing Falls – Infection Control / Hand Hygiene (support HCAI)
Toolkits completed or in progress to support these
Primary Care Quality and Informa3on Service
Clinical Governance Practice Self Assessment Tool Objectives for the production of a web
based tool: • To be used by practices to review progress made in
the development of CG processes within their practices
• To provide assurance to HBs of the same • Reference for inspecting bodies, such as HIW as
evidence that appropriate CG activity is occurring in practices
• That can support revalidation
Primary Care Quality and Informa3on Service
The Principles • Standardised model across Wales • Developed by practitioners and other
stakeholders • Endorsed by GPC Wales & RCGP • Designed to help practices review,
monitor & improve systems within their practice
• Completed by practice team
Content • Patient experience – environment, access • Health & Safety – infection control, waste,
premises, security • Risk management – clinical risk, business risk • Clinical effectiveness – guidelines, audit • Prescribing • Relationships with external bodies • Workforce – skills, recruitment, appraisal,
training • Leadership
Primary Care Quality and Informa3on Service
Primary Care Quality and Informa3on Service
CGPSAT – Supporting the GMC Deanery
Revalidation Project • Pilot Project run in Wales 2008-9 • Three robust single systems fundamental to GMC
criteria – Appraisal – Managing performance concerns – Clinical Governance
• Project tested the three systems in general practice and engagement by LHBs – Wales is advancing ahead in UK with national linked systems
Primary Care Quality and Informa3on Service
CGPSAT – Supporting the GMC Deanery
Revalidation Project • If these systems not in place, practices and LHBs
would have to generate evidence on CG through other routes
• CGPSAT useful, could be used by LHBs better. Needs to be more robust
• Substantial changes made to CGPSAT in 2010-will be released in November
New Work - Predicting/ Identifying Areas of Risk & Good Practice: Practice Profiling
• CGPSAT • QOF • Audit • Questionnaires • Complaints and
incidents • Immunisations • Risk assessment
• Referrals • Hospital data • No of staff WTEs • List size per
notional WTE • Deprivation • Income/Cost per
patient
Integration Service
• Coordinating function which facilitates delivery of public health through primary care
Teaching • Contributing to undergraduate and postgraduate
teaching • Input into curriculum development
Research • Evidence into practice • Identify topics for research
