1. MORNING SESSION – GP STUDY DAY, 20 MAY 2014

2. Progress so far SWCCG had a 0% increase in GP referrals April- Feb
Wyre forest 9.51%
R&B 18.08%
Very crudely done, but applying the 9.51% increase to SWCCG, would have meant an extra 3,168 1st OP attendances in 2013/14 at a cost of £1,262,758

3. AIMS-INTRODUCTORY SESSION
QP\QIPP STUDY DAY update
IQSP & 13\14 QIPP ACHIEVEMENT
ANALYSIS OF GP APPOINTMENT TOOL-GP CAPACITY & DEMAND – IMPACT ON SYSTEM
LOCALITY COMMISSIONING FRAMEWORK:PROPOSAL PRACTICE SERVICE DEVELOPMENT FUND-1ST OP ATTENDANCES

4. Veronica Wilkie GP Corbett Medical Practice Academic and Learning Lead SWCCG Retired GPwSI dermatology

5. AIMS-MORNING SESSION
TO IDENTIFY SERVICE IMPROVEMENTS IN EXISTING PATHWAYS FOR ENT, CARDIOLOGY, RESPIRATORY & PAEDIATRICS
TO ENABLE PRACTICES TO BETTER MANAGE CERTAIN CONDITIONS IN PRIMARY CARE
TO INFORM WIDER SERVICE REDESIGN
TO SUPPORT CHANGES TO ACUTE CONTRACT 15\16
TO IDENTIFY & HARNESS CLINICAL DEBATE & EXPERTISE TO SUPPORT THE CCG QIPP PROGRAMME

6. The CCG “QIPP Challenge” for 2014/15
To make the books balance next year, as a CCG we need to achieve:
2% reduction in A&E attendances – real reduction
6% reduction in emergency admissions – real reduction
5% reduction in outpatient appointments – real reduction
Flat position on prescribing expenditure – consume growth and inflation
………. And something similar in the year after that, except:
9.5% reduction in emergency admissions

10. Q2 –Has your clinical practise been influenced by participating in the IQSP visits?

11. Practice access calculations- Please enter your values in the green cells. White cells will automatically update
List size of practice
15,088
Recommended number of consultations per patient per year
4.1
Recommended number of consultations per year
61,861
Patients per week expected
1,190
Full time equivalent
Annual leave in days per year for a FTE (excluding bank holidays)
Number of days actually on leave (pro rata from FTE figures) adding on 8 standard bank holidays
Number of appointments per week taken out for other clinical committments and not covered by locum
Name/Type of Doctor
Dr O'Driscoll
0.875 40 42
Corrected leave/backfill leave. This is the actual amount of leave that requires cover with the amount of leave. It includes 8 days bank holiday 3
Dr Morgan 1 48 17
Dr Wright
Dr Blaine
0.625 30
Dr Jones
0.5 24
Dr Tomlinson
Dr Bond
0.75 36
Dr Samuel
Dr N Noore
Dr G Moore
Dr Macaskill 35 43
Total
8.5
435
403
12.8% 44
18.2%
Yearly figure
Weekly average
Number of appointments taken up by minor operations and procedures done in one year during clinic times and not included in appointments covered by locum (eg.Joint Injections during surgery time)
1,437
27.6
Doctor Average Appointment calculator
Nurse appointments
How many Full Time nurse practitioners?
Doctors
Annual leave per nurse (FTE days per year excluding bank holidays)
Morning
Afternoon
Number of appointments per week unavailable (clinical meeting)
How many appointments in a session? 16
% of full year unavailable for surgery
0.0%
How many total sessions (all doctors)? 45 0%
Average
16.65
Nurse practicioners
If you compete the average appointment calculator please use the average calculation for appointment numbers 20
Doctors average
Nurse average
How many total sessions (all nurses)? 5 10
How many appointments in a session/clinic?
18.00
How many sessions/clinics per week for a full time employee? 8
Total appointments for a full time employee per week
133.2
180.00
Average Number of Locum Appointments per year
1434
Average number of home visits per year
1,666
Total appointments drs
765
384
Extra Average per week
59.6
Total appointments nurses
100 80
Evidence suggests the practice needs:
Total number of appointments needed
The Practice has
Number of nurse appointments -
Number of GP appointments
1,132
Grand total
before Holiday allowances
Number of nurse appointments (minus annual leave)
Number of GP appointments (including triage and minus leave)
988
after Holiday allowances
Grand total minus additional clinical commitments + loums/ visits
976
Overall deficiency/excess of appointments per week
214
Overall GP session deficiency per week 13
Annual number of appointments needed
Annual Shortfall/excess of appointments
11,126.54
Percentage shortfall
18%
Maximum Leave calculations
Maximum number of doctors/nurses that can be on leave at any one time
summary box
Number of appointments missing in one week if entered number of full time doctors are on leave at any one time
400
Total number of appointments before holiday allowances
Excess/deficiency if maximum number on leave at same time
529
47%
Actual Number of appointments per year
Number of Patients seen in surgery
41,370
Number of telephone consultations
6,936
Number of Home Visits
49,972
Rceomended number of consultations per year
Actual Number
Shortfall/ Excess
,889
Shortfall/ Excess percentage
19.2%

12. Number of appointments (related to 4.1)

14. Coffee time

16. Conflicting demands on appointments
Rising patient demand for appointments (3-4.1) (27% increase)
Rising duration of appointments from 8.6 to 11.9 minutes
Rising government demand (health checks etc.)
Rising complexity of appointments
Need to look after frail elderly
Need to subspecialise for QIPP
Need to retain GP’s

17. continuity, and a saving of £2641 per hospital admission.
A study examining the
impact of continuity found that a 1% increase in the proportion of patients able to see a
particular doctor was associated with a reduction of 7.6 elective admissions per year in the
average-sized practice for 2006–2007 and 3.1 elective admissions for 2007–2008. This equates
to considerable cost savings across a whole practice of £20,000 per year for a 1% increase in
continuity, and a saving of £2641 per hospital admission.
Chauhan M, Bankart JM, Labeit A, Baker R. Characteristics of general practices associated with numbers of elective admissions. Journal of Public Health. 2012; 34(4): 584–90.

18. Continuity of GP care is related to reduced specialist healthcare use:
The probability of visiting outpatient specialist services was significantly lower among those participants who have seen the same GP for >2 years
Similar findings were found for hospitalizations
Stratified analyses revealed that these associations were not dependant on self rated health or age.
BJGP July 2013 Anne Helen Hansen, Peder A Halvorsen, Ivar J Aarraas and Olave Helge Forde

19. Figure 6: Primary and secondary healthcare costs commissioned by primary care trusts, 2003–2011

21. Building Resilient Primary Care & Supporting Practices to Thrive

22. Less Patients per WTE GP
What is the most cost effective number of Patients per WTE GP?

23. National Cancer Patient Experience Survey 2012/13 for Worcestershire Acute Hospitals NHS Trust
question 64 in particular asking patients if GP practice staff definitely did everything they could to support patients, 95% of lung cancer patients surveyed in the trust felt they were very well supported and everything was done by primary care to support them (national average score for this question was 69%).

26. Veronica Wilkie GP Corbett Medical Practice Academic and Learning Lead SWCCG Retired GPwSI dermatology

27. Could anything else have been done in the practice to avoid referral?
22% could have intervention to reduce referral 28% could have been managed with extra expertise

28. Which areas to focus on We are very accurate at diagnosing BCC
We are less accurate with seborrheic warts and actinic keratosis

29. Points for discussion Dermatology Road Shows
In practice referral screening service
Greater prevalence of GPs with Diploma in practical Dermatology
Experience and availability of GPwSI

30. Proposed Model of primary care to look at reducing secondary care referrals1
Core Primary care
(needs defining) 2
Enhanced primary care
(e.g. Cardiff diploma in dermatology) 3
Community GPSI/community service 4
Secondary Care

33. Plan
Practice identifies a lead GP per specialty they wish to work on (paid 750 per specialty)
Practice keeps 50% of any savings of 1st outpatient referrals if they reduce below 2013/14
CCG keeps 50% + follow up savings
Federation is paid 1000 per specialty to coordinate education and support practices

34. Who could be a lead GP Depends on speciality
Dermatology: Cardiff diploma – clinical assistant, worked in dermatology as an SHO, GPSI
ENT worked in this specialty
Cardiology – previous cardiology experience or an interest and willing to attend education sessions.

35. Next Steps
Practice identifies leads and coordinates though localities.
Attends 2 out of 3 education sessions for that specialty
Works with CCG support and federation
Uses evidence from audits to look at areas most likely to reduce referrals.

36. Today Would this specialty fit into this model
Dr Kameen’s top tips are: -Do you use your trainees referrals as a learning opportunity?
-Ask trainees to discuss all potential referrals prior to being sent and use these to explore the range of options to manage that patient
-How robust if the trainees decision making?
-Does it follow local pathways or NICE guidance?
-Is this the most cost effective way of managing the patient given local resources?
-Also makes a great clinical encounter for trainees to write up in their learning log
Today
Would this specialty fit into this model
Do you have a lead GP who may wish to take on this area
Are there some categories of referrals which should be considered for cross referral.
Is there a list of categories of referrals which should not be cross referred

37. Dr Kameen’s top tips are: -Do you use your trainees referrals as a learning opportunity?
-Ask trainees to discuss all potential referrals prior to being sent and use these to explore the range of options to manage that patient
-How robust if the trainees decision making?
-Does it follow local pathways or NICE guidance?
-Is this the most cost effective way of managing the patient given local resources?
-Also makes a great clinical encounter for trainees to write up in their learning log
Dr Kameen’s top tips are: -Do you use your trainees referrals as a learning opportunity?
-Ask trainees to discuss all potential referrals prior to being sent and use these to explore the range of options to manage that patient
-How robust if the trainees decision making?
-Does it follow local pathways or NICE guidance?
-Is this the most cost effective way of managing the patient given local resources?
-Also makes a great clinical encounter for trainees to write up in their learning log
Registrar referrals
Dr Kameen’s top tips are: -Do you use your trainees referrals as a learning opportunity?
-Ask trainees to discuss all potential referrals prior to being sent and use these to explore the range of options to manage that patient
-How robust if the trainees decision making?
-Does it follow local pathways or NICE guidance?
-Is this the most cost effective way of managing the patient given local resources?
-Also makes a great clinical encounter for trainees to write up in their learning log

38. Feedback on audits
Good quality
Thorough investigations