Primary Healthcare – Priorities for Improvement 18th November 2014 Primary Healthcare – Priorities for Improvement Paul Gimson, 1000Livesi

Excercise On your tables, agree and sketch a picture of ‘primary care’ as you see it now...

Summary The Evidence Primary Care CEO Conference Prudent Primary Care NUKA Welsh Government Primary Care Plan

What is Primary Care? First contact, continuous, comprehensive and co-ordinated care provided to individuals and populations undifferentiated by age, gender, disease and organ systems The service should be: Comprehensive, person-centred, population oriented, coordinated, accessible, safe and high quality. Primary Care in Wales: Rapid review of models and policy www.wales.nhs.uk/sitesplus/888/page/74467

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Increasing and complex demand on primary care Our population is increasing and getting older More people are being diagnosed with one or more long-term health conditions like diabetes and dementia Frail and older people increasingly have more complex needs Insert name of presentation on Master Slide

What does the evidence say? In order for primary and community care to be delivered from a population health perspective then; Provision would need to be scaled up, delivering through federations/super-partnerships, and variation and inequality would need to be reduced. Planning and commissioning needs to be needs based, make better use of community assets and aim to integrate services Insert name of presentation on Master Slide

What does the evidence say For this to happen, and for change to accelerate, there needs to be; A clear vision Better engagement with citizens and stakeholders Pragmatic change at all levels A plan that is relevant to all Resources – including people Insert name of presentation on Master Slide

Primary Care CEO Conference Vision Priority Workforce Local mapping of resource and infrastructure Outcome data Integration – planning, finance, estates, services, LHB structure and leadership IT and information sharing Co-production Insert name of presentation on Master Slide

How do the principles of Prudent Healthcare apply to primary care Minimise avoidable harm Carry out the minimum appropriate intervention Promote equity between the people who provide and use the services Insert name of presentation on Master Slide

Prudent Primary Care Three things you may not know about prudent healthcare It directly involves patients in designing their own care and participating in co-creating services It focuses on obtaining the best outcomes for patients, discarding practices which are of marginal or no benefit, or may even cause harm It is allied with a global movement seeking to reduce harmful overmedicalisation

Implementing prudent healthcare in primary care Greater focus on prevention, promoting wellness and healthy behaviours, improving community cohesion Prudent Prescribing Shared goal setting and shared decision making (better outcomes & use of evidence) Working with secondary care – alternatives to referral, improving access to specialists & patient experience Refraining from interventions with low clinical value and no robust evidence base Insert name of presentation on Master Slide

Prudent Primary Care – Next steps SDM – Opportunity, resource and capacity Using evidence effectively to reflect co-morbidities, elderly population and polypharmacy Co-production – information and resource to support collaboration and integration Prudent prescribing and tackling polypharmacy Insert name of presentation on Master Slide

Evidence Based Medicine: a movement in Crisis? BMJ 13th June 2014, T Greenhalgh, N Maskrey and J Howick Talks about the unintended consequences of ‘Evidence Based Medicine’ Insert name of presentation on Master Slide

The problem with EBM? Distortion of the brand Too much evidence Marginal gains and a shift from disease to risk Overemphasis on following algorithmic rules Poor fit for multimorbidity Insert name of presentation on Master Slide

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A return to real evidence based medicine Individualised for the patient Shared decision making Co-production Judgment not rules Aligned with professional, relationship based care Public Health Dimension Insert name of presentation on Master Slide

The Nuka System of Care Recognised as one of the most successful primary care systems in the World A community-led model of ‘customer ownership’ Health outcomes of community significantly improved Insert name of presentation on Master Slide

Nuka 95% population have access to a primary care integrated team (up from 35%) Reduction from 4-week delay to schedule an appointment to same-day access Staff turnover a quarter of what it was five years later Insert name of presentation on Master Slide

NUKA – Changing the Primary Care Paradigm Outcome not income Person not disease Population not process Service not practice Insert name of presentation on Master Slide

Lessons from NUKA for NHS Wales? The importance of personal, longitudinal holistic care with small teams rather than individuals The development of multi-disciplinary teams with a focus on early intervention and meeting the needs of patients who live with self-limiting illness and chronic conditions The importance of appropriate skills and team building; pharmaceutical advice, nursing care, administrative support Using thorough, frequent metrics to monitor service provision and individual clinical standards Insert name of presentation on Master Slide

How? Leadership Organisational development Clinical Engagement Values driven working and recruitment culture A greater emphasis on patient-set goals and priorities Exploring lifestyle interventions rather than medical responses Understanding (and delivering) what matters most to people who use the service Insert name of presentation on Master Slide

WG – Primary Care Plan From the Ministers introduction; “No GP shuold routinely be undertaking any activity which could, just as appropriately be undertaken by an advanced nurse, a clinical pharmacist or an advanced practioner paramedic” “At the centre of this plan is the notion of co-production – the recognition that health outcomes are maximised when the contribution of the patients as well as practitioners is captured and put to work” Insert name of presentation on Master Slide

WG Plan – 5 areas for action Planning care locally Improving access and quality Equitable access A skilled local workforce Strong leadership Insert name of presentation on Master Slide

To Throw into the mix... RCGP – Putting patients first GPC Wales – Prescription for a Healthy Future Royal Pharmaceutical Society Wales – Your Care Your Medicines Trusted to Care and others Insert name of presentation on Master Slide

So... Given all that – Sketch a picture of how you think primary care might look when all of ‘this’ becomes reality What are the major differences? How can we move (at scale and pace) from one picture to another? What are the priority areas of change?

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