Transcript Primary Care

Primary Care:
Working on a new set of standards
Su Long
Chief Officer
Our Vision:
Our Legacy:
Specialised services
In- Hospital services
Specialised
services
InHospital
services
Community
services
Services in
community &
peoples homes
Primary
care
Primary care
Self care
Self care
Public Priorities (from our engagement)
 More people should be supported to remain independent
in their own homes
 Support spending more money on community services,
mental health and prevention, and less on hospital services
 Assurance of high quality of care in the home
 Services should be designed to fit around the individual
 Improved access to a GP
 Embrace technology (to support people to self-care, or to
improve access)
Linked Strategies to deliver our
commissioning plan
CCGs
Clinically led in-hospital redesign working
of acute services across Greater together
across GM
Manchester (GM)
Healthier Together
Specialised
services
InHospital
services
Services in
Community and
peoples homes
Primary care
Bolton Integration Plan
Q
I
P
P
Redesign of services to support
more elderly people with long
term conditions in their home.
Reduction of hospital
admissions
Redesigned intermediate tier
service with 24/7 support.
GM Primary Care Strategy
The core requirements of
Primary care and redesign to
meet future demand
Bolton Self Care Strategy
Self care
CCG,
Bolton
Health &
Wellbeing
partners
NHS England
Area Team &
CCG
CCG, with
Public Health
General Practice – national news
 Party conferences responding to ‘NHS in crisis’
 National GP organisations:
– Not enough GPs being trained
– Many GPs near to retirement
– Working days getting more pressured/stressful
– Proportion of NHS Budget for GP reducing
One pot of money for Bolton
Demand & costs increasing
- New procedures offered
- New drugs
- More diseases can be treated
- Ageing population
- Inflation (staff pay, utilities, etc)
Growing 4%
per year
Proportion of NHS Budget
spend on General Practice
10.4% - 8.4%
general
practice
medicines
mental
health
acute
community specialist
General Practice pressures
 Increasing demand - ‘todays work’
– The frail elderly
– People living longer with more diseases
– People discharged earlier from hospital needing support
– Inability to self care or reassurance needed
– The worried
– Other services with criteria saying no
Risks this creates?
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Reading increasing volumes of mail
Reviewing increasing volumes of results
No time for proper medication reviews
Taking the quickest option
Decision making fatigue
Over investigation
Over referring, not following best practice
Not giving time to proactive care – ‘tomorrows work’
GPs retiring
What are the answers?
 Investment in Primary Care to increase capacity,
improve access and improve quality of care
 Getting more out of Primary Health Care team
 Using community services or integrated neighbourhood
teams where appropriate
 Reducing duplication
 Spending longer with people who need it to help them
stay more healthy for longer = proactive care
Using ‘Triple Aim’ to improve
Better
Health
Value for
money
Best quality
care and
experience
The aim of our draft standards
 Bring together some things we already require of GPs
 Add strong focus on access, quality and prevention of ill-health
 Benefits to Bolton people:
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Get to see a GP when they need to
Better experience, improved support close to home
Better health through getting the best care, early
Reduce wasted hospital appointments
 Investment in capacity will be needed to meet the standards
 By meeting these standards, the shift to more care out of hospital
will be supported
 The improved quality of services & reduction in unnecessary
hospital visits will pay for themselves
What we need to do to make this happen?
 Make the case this is the right thing to do for Bolton people
 Get agreement from CCG Board that the investment can be
made
 Get agreement from NHS England & Public Health to jointly
commission this new quality contract with the CCG
 Get agreement from all Practices to sign up to this new
quality contract
… we are seeking your views first
A new set of standards for
General Practice in Bolton
– your views are important
Standards so far….
 More responsive access
 Safer prescribing, less waste
 Referring at right time to
right place
 Health checks
 Best care for people with
long term conditions
 Vaccinations
 Sexual health
 Cancer referrals & learning
 Patient experience
 Phlebotomy/ taking blood
 Carers registers & health
checks
 Mental health, dementia,
Learning disabilities
 CCG quality incident
reporting, education
 End of life care
Standard 1 - Access
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8.00 – 6.30pm, Monday to Friday
10 bookable sessions
Access to both male and female GP
Minimum number of appointments per 1000 population
Pre-bookable appointments 3 months in advance
Process for unplanned / urgent appts
Offer telephone consultations
Children under 5 seen same day
Accept deflections from services to prevent hospital admission
How should we measure access?
 Reduce use of out of hours
 Reduce minor A&E attendances during Practice hours
 Improve on the Patient Survey measures:
• % of patients who were able to get an appointment to see or
speak to someone at the surgery on the day they wanted to.
• % of patients reporting that they were very happy or fairly
happy with their experience of getting through to someone
at the surgery on the phone.
• % of patients who were very satisfied or fairly satisfied with
opening hours at the practice.
QUESTIONS
 Questions?
 Please comment on what you’ve heard:
– Is a Bolton quality contract with standards for
General Practice a good idea?
– Any particular standards you would add?
– How can we ensure patient experience is heard on
access, and in general views of General Practice?