Primary Care – Changing Future 1 PRIMIS 23 rd April 2002 Metropole Birmingham

2 Primary Care The changing future

Primary Care – Changing Future 3 What will change? What we do Who we work with How we plan, develop and deliver services

Primary Care – Changing Future 4 What will change? What we do Who we work with How we plan, develop and deliver services

Primary Care – Changing Future 5 The Concept of Migration Volume of Activity Distance HomePracticeLocalityDGHSub Regional RegionalSupra Regional NationalPCT

Primary Care – Changing Future 6 What will change? What we do Who we work with How we plan, develop and deliver services

Primary Care – Changing Future 7 Partnerships

Primary Care – Changing Future 8 Primary Care Secondary Care Social Services Planning for change Intermediate care Operational Strategic Referral and discharge protocols Maximising independence Discharges and delayed discharges Balancing capacity and demand Throughput planning and admission prevention Health promotion and disease prevention Integrated service planning and delivery

Primary Care – Changing Future 9 What will change? What we do Who we work with How we plan, develop and deliver services

Primary Care – Changing Future 10 KEY WORDS Priority Quality Access Equity Demand Supply Modernisation

Primary Care – Changing Future 11 DemandCapacity Met need Unmet need Service demand and capacity

Primary Care – Changing Future 12 Demand management? The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

Primary Care – Changing Future 13 Demand management? The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

Primary Care – Changing Future 14 Demand management? The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

Primary Care – Changing Future 15 Demand management? The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

Triage for primary care Prevention Self-care Community multidisciplinary teams - care at home GP booking schemes NICE referral guidelines Priority scoring systems Form referral letters Direct booking at O/P appointments Nurse led pre-assessment clinics Clinics outside normal working hours Consultant out-reach clinics GP clinical assistants in O/P PCT held waiting lists Waiting list validation Facilitated early discharge Intermediate care services Hospital at home schemes One stop rehab teams consultation Telemediine GP specialists Different use of GP time Alternatives to GP Systematic secondary prevention in primary care Survey high DNA rates Develop DNA policy Follow up reviews Primary based alternatives to hospital delivery eg minor surgery Triage for secondary care PATIENTGPO/P REFERRALO/P CLINICWAITING LISTPROCEDUREDISCHARGE

Primary Care – Changing Future 17 DemandCapacity Met need Unmet need Adjusting referrals

Primary Care – Changing Future 18 DemandCapacity Met need Unmet need Adjusting referrals 1:3 referrals may be avoidable 1:6 referrals may be avoidable with targeted GP education 110%

Primary Care – Changing Future 19 DemandCapacity Met need Adjusting referrals 1:3 referrals may be avoidable 1:6 referrals may be avoidable with targeted GP education

Primary Care – Changing Future 20 DemandCapacity Adjusting referrals 1:3 referrals may be avoidable 1:6 referrals may be avoidable with targeted GP education Met need MetFilled Protocol driven referrals

Primary Care – Changing Future 21 DemandCapacity Met need Unmet need More than 10%imbalance

Primary Care – Changing Future 22 DemandCapacity Must have secondary care Could be done in primary care Adjusting services

Primary Care – Changing Future 23 DemandCapacity Must have secondary care Could be done in primary care Adjusting services

Primary Care – Changing Future 24 DemandCapacity Must have secondary care Could be done in primary care Adjusting services

Primary Care – Changing Future 25 DemandCapacity Must have secondary care Could be done in primary care Adjusting services

Primary Care – Changing Future 26 Unmet needCapacity filled Must have secondary care Could be done in primary care Adjusting services

Primary Care – Changing Future 27 DemandCapacity Must have secondary care Could be done in primary care Adjusting services

Primary Care – Changing Future 28 DemandCapacity Must have secondary care Could be done in primary care Adjusting services

Primary Care – Changing Future 29 DemandCapacity Must have secondary care Could be done in primary care Adjusting services

Primary Care – Changing Future 30 DemandCapacity Could be done in primary care Adjusting services Must have secondary care Protocol driven referrals

Primary Care – Changing Future 34 Endoscopy services

Primary Care – Changing Future 35 Nuffield access equates to high referrals Average gastroscopy activity is 5.4 per 1000 population Activity rates - City PCT

Primary Care – Changing Future 36 Expectation of need BSG Working Party Report 2001 Put these figures back to the upper GI diagnostic graph

Primary Care – Changing Future 37 Nuffield access equates to high referrals Average gastroscopy activity is 5.4 per 1000 population Activity rates - City PCT Average Expected Expected increase

Primary Care – Changing Future 38 Expectation of need BSG Working Party Report 2001 More procedures needed for City: Upper GI diag1646 Flex Sig 368 Colonoscopy 473 Total2487 or 50 procedures per week 60 extra NHS procedures per week if include Nuffield activity 27 MORE colonoscopies per week predicted by BSG

Primary Care – Changing Future 39 Primary care managing throughput Delayed discharges (5/95) Managing care Managing waiting lists –Clinically –Comparatively

Primary CareSecondary Care Referred patients Discharge Poor management of referred patients during wait Poor management of waiting lists Little co-ordination between various agencies Protracted affair Push system Delay inevitable

Reduced independence Pre-intervention and reablement function Primary Care Secondary Care INTERVENTION Best independence Reabling independence Admission avoidance

Primary Care – Changing Future 42 Balance Between demand and capacity Between availability and need Between needs and wants

Primary Care – Changing Future 43 PRIMIS 23 rd April 2002 Metropole Birmingham