1. 1 NICKY BROOKS DEVELOPMENT MANAGER PRACTITIONERS WITH SPECIAL INTERESTS TEAM NatPaCT

2. 2 PwSIs and Impact Assessment Background National Impact Assessment The Impact Assessment Tool for Local Work Case studies

3. 3 Background Experience of meeting PCT staff across England Issues around choosing the most appropriate measure Issues around baseline measures Need for a tool with a menu of options for local services

4. 4 National Impact Assessment MA Action on Programme (October 2002) www.york.ac.uk/inst/yhec Compilation of 6 GPwSI pilot sites Consistent objectives – increase access, reduce waits, streamline patient journey, develop / spread best practice and link 1 / 2 care GPwSIs dealt with range of conditions At time of the evaluation 5/6 of the services been established 9 months or less http://www.york.ac.uk/inst/yhec http://www.york.ac.uk/inst/yhec

5. 5 National Impact Assessment Process related findings Activity analysis 30-40% referrals 2 care could be managed by GPwSI 70-80% patients discharged back to GP Reduced follow up ratio in 1 care 15-20% patients ref. consultant opinion or direct onto WL Low DNA rates 1-2% Capacity 1 clinic per week 9-10 patients (p.a. 420-500 / 320-400 new patients Surgical GPwSI 4 adult tonsillectomies per week 150-180 p.a.

6. 6 National Impact Assessment Weekly clinic without audiological support Workload for 75,000 approx With audiological support 120-150,000 Patient satisfaction surveys unanimous praise ENT consultants largely positive, GPwSIs enjoyed challenges

7. 7 National Impact Assessment GPwSI Orthopaedic Services University of Leicester (May 2003) www.le.ac.uk/cgrdu/pcd.html /pcd.html/pcd.html Involved 3 city centre PCGs RCT to test GPwSI in 1 / 2 care Treating back and knee problems Service objectives – to improve patient management, reduce inappropriate referrals, and deliver good health status and patient satisfaction

8. 8 National Impact Assessment Little difference between two methods of delivery Initial waits GPwSI 7 weeks Consultant 17 weeks, increased to 13 weeks and 19 weeks 70% patients discharged back to GP after 1 appointment 9% seen 3 times or more Main interventions: advice, prescription, X- ray, manipulation, injection 5% referred onto Consultant QOL first 3 months improved Patient satisfaction largely positive (15 / 263 patients had negative comments

9. 9 National Impact Assessment GPs in PCG 80% return – 82% had referred into service More than 80% happy with outcomes Consultants 100% return - 50% had seen patients from GPwSI clinic 7 agreed with treatment given GPwSI referrals to ENT Consultant 6/10 mostly appropriate

10. 10 National Impact Assessment Specialist PwSI Clinics Kings Fund (December 2004) www.sdo.ishtm.ac.ukw.sod.isthmus.ac.aukw.sod.isthmus.ac.auk Service objectives – access, patient / clinician satisfaction, costs to the patient and the NHS Final report not yet available – interim report Waits / case mix Mean wait 38 days DNAs 7.4% Cancellations 2%

11. 11 National Impact Assessment Outcomes 37% PwSI follow up 22% discharged 8% sent back to GP 6% referred to hospital 1% awaiting test results 1% sent elsewhere 23% data missing Reasons for referral Advice on clinical management 68% Having a procedure 47%

12. 12 National Impact Assessment Seeking a diagnosis 30% Second opinion 23% ½ GP using services reported quicker waiting times 1/3 GPs using the services reported lack of clarity of referral guidelines Wide variations in accrediting GPwSIs, training, CPD Lack of clarity about where responsibility lay Costs and value for money difficult to establish due to free goods

13. 13 National Impact Assessment Primary Care Dermatology Service, University of Bristol (April 2005)h www.sdo.ishtm.ac.ukw.h w. Effectiveness, cost effectiveness, accessibility and acceptability RCT comparing care with usual hospital care Triage in acute care with Consultant and GPwSI Measures disease specific and global QOL, patient views on accessibility, DNA rates and waiting times Process measures – what happens to patients once referred Economic analysis – including costs from a societal perspective – NHS and patients

14. 14 The Impact Assessment Tool Two main aspects 1. Areas to consider when designing PwSI services 2. Options for evaluating the impact of PwSI services Areas to consider when designing PwSI services: Objectives of a PwSI service Is the service able to provide comparable care? Does the service offer value for money? Is the service providing patient-centred care? What is the impact of the service on staff working in 1/ 2 care?

15. 15 The Impact Assessment Tool Options to consider Provides references to existing websites with resources and some specific tools already tried and tested

16. 16 Case Study One COPD PwSI Service Service outline: GPwSI 2 sessions per week (1 clinic, I developmental / educational) NwSI 6 sessions per week (1 clinic, 5 developmental / educational) What would be your short, medium, long term objectives and impact assessment measures?

17. 17 Case Study Two Heart Failure PwSI Service Service outline: GPwSI 1 session per week (one stop clinic) Pharmacist 1 session per week (one stop clinic) NwSI 10 sessions per week (1 clinic, 9 developmental / patient review/ care) What would be your short, medium, long term objectives and impact assessment measures?

18. 18 CONTACT DETAILS: 07766 020 468 NICKY.BROOKS@DH.GSI.GOV.UK