Transcript Slide 1

GERAINT WYNNE - JONES
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INDEPENDENT
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NOT from LHB
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NOT from TRUST
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NOT from OOH PROVIDER
DECLARATION OF
INTEREST
(PERSONAL NOT FINANCIAL)
WHEN ALL IS SAID AND DONEA LOT MORE IS SAID THAN DONE
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W.E.C.A.C.
D.E.C.S
DESIGNED FOR LIFE
MAKING THE CONNECTIONS
WANLESS
1000 LIVES
FULFILLED LIVES,SUPPORTING COMMUNITIES
M.U.C.
TIME TO MAKE A DIFFERENCE
MODERNISING UNSCHEDULED
CARE
M. U. C.
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The
Medusa of Unscheduled Care
UNDERSTANDING OUR MEDUSA
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WHAT IS UNSCHEDULED CARE?
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HOW BIG IS THE PROBLEM?
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WHO ARE THE “SNAKES”?
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$ 6,000,000 ? HOW?????
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WHAT CAN PRIMARY CARE OFFER?
WHAT IS U.C.?
ANY UNPLANNED HEALTH OR SOCIAL
CARE TO PATIENTS WHO NEED HELP TO
CARE FOR THEMSELVES AT HOME
WALES AUDIT OFFICE
NOVEMBER 2008
ANY EPISODE OF CARE PROVIDED FOR
THE PATIENT WHICH IS UNPLANNED AND
MAY REQUIRE PROMPT ACTION IN
RESPONSE TO AN ACUTE, MINOR OR
MAJOR INJURY OR ILLNESS
WAG 2008
HOW BIG?
UNDERSTANDING HOW THE
PUBLIC CHOOSES TO USE
UNSCHEDULED CARE SERVICES
: AWARD
:CHIRAL
:June 2008
HOW BIG?
WALES 2007- PATIENT CONTACTS
A+E
740,326
NHSD
360,000
GP
2,650,000
(ESTIMATED)
UNSCHEDULED CARE
3000000
2500000
2000000
1500000
1000000
500000
0
NHSDW
A+E
GP
UNSCHEDULED CARE –TRUE PERSPECTIVE?
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FIRST CONTACTS
GPs
63.5%
NHSD
6.0%
A+E
5.5%
999
3.3%
MIU
1.1%
MEDICAL STAFFING LEVELS
1997 TO 2007
2000
1800
1600
1400
1200
1000
800
600
MEDICAL
CONSULTANTS 1997
MEDICAL
CONSULTANTS 2007
A+E CONSULTANTS
1997
A+E CONSULTANTS
2007
GPs 1997
400
200
0
GPs 2007
HEALTH BUDGET SCOTLAND 2006-07
(£BILLION)
9
8
6
TOTAL HEALTH
BUDGET
HOSPITAL CARE
5
COMMUNITY CARE
7
4
3
2
1
0
AMBULANCE ETC
FAMILY HEALTH
CARE
FAMILY HEALTH CARE 2006-07
(£BILLION)
2.5
2
1.5
1
0.5
0
FAMILY
HEALTHCARE
PRESCRIBING
DENTAL /
OPTHALMIC
PRIMARY MEDICAL
HOW BIG IN 2031 ?
POPULATION WILL INCREASE BY
11%
PENSIONERS WILL INCREASE BY
31%
WHO ARE THE “SNAKES”?
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GPs
W.A.G.
TRUSTS
LHBs
WAST
NHSD
SOCIAL SERVICES
MENTAL HEALTH
PHARMACISTS
I.T.
PRESS
PATIENTS
SOLICITORS
W.A.G.
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CONSTANTLY SEEM TO WANT TO BE SEEN
DOING SOMETHING ABOUT THE POLITICAL
HOT POTATO OF HEALTH
THEY ENCOURAGE THE “MEETINGS” CULTURE
THEY CREATE SOME OF THE U.C. PRESSURES
THEY NEED TO GIVE CLEAR GUIDANCE TO
PATIENTS
THEY ARE OBSESSED WITH DATA AND EXERT
NEEDLESS PRESSURE BY TARGETS
“Politicians use statistics like a drunk uses a lampost –
for support not illumination”
ANDREW LONG
Do A+E clinical staff feel able to deliver acceptable
standards of service within the 4 hour target?
Paul Stevens M.A. Business Management Thesis 2008
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95% front line staff felt that the imposition
of the 4 hour target had negatively
impacted on the clinical care of patients.
Pressure to meet time limit conflicted with
professional care standards.
Quantitative care was secondary to
qualitative care.
TRUSTS
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HAVING A HARD TIME LATELY
HAVE MADE SOME VERY POSITIVE CHANGES
TENDENCY TO BE SELF – CENTERED
SOMETIMES ONLY PAY LIP-SERVICE TO THE
CONCEPT OF CO-OPERATING WITH THE
WIDER HEALTH COMMUNITY?
LHBs
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LOCALLY “DISTANT”
IDENTITY CRISIS – REPRESENTING
PRIMARY CARE - BUT ARE THEY?
PROPOSED CHANGES 2009 MAY IMPROVE
LINKS WITH GRASS ROOTS
L.E.S. AND D.E.S. IMPACT ON PRIMARY
CARE CAPACITY TO PROVIDE U.C.?
WAST
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THE GLAMOUR BOYS (AND GIRLS) OF U.C. !
HARD WORKING
MADE BIG CHANGES TO WORKING PRACTICES
BEST USERS OF THE MEDIA TO ACHIEVE
THEIR AIMS (SLIGHT PRIMA DONA COMPLEX?)
THE IMPACT OF EXTENDED ROLE
PARAMEDICS ON U.C.?
NHSD
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ON GOING IMPROVEMENT SINCE LINK
WITH WAST
WHY NOT MORE POPULAR WITH THE
PUBLIC?
WHAT SCOPE FOR INCREASING CALLS?
 COMPUTER
SAYS…….
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CALL YOUR GP
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DIAL 999
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GO TO A+E
SOCIAL SERVICES
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A VAST ARMY OF “SNAKELETS” WORKING
BEHIND THE SCENES
OFTEN VILLIFIED BECAUSE NOT
AVAILABLE 24/7 AND NOT SEEN
A VITAL ROLE IN THE KEEPING IN, AND
RETURNING OF PATIENTS TO, THEIR
COMMUNITY
BACK INTO THE VIVARIUM OF
HEALTHCARE?
MENTAL HEALTH TEAM
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A SMALLER GROUP OF PATIENTS BUT MORE
TIME-CONSUMING OF STAFF
APPEAR TO HAVE DIFFERENT
TIME-SCALES TO THE REST
PHARMACISTS
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MINOR AILMENT ADVICE MAY RELEASE
CAPACITY IN PRIMARY CARE BUT NO
DATA TO SUPPORT THIS SERVICE?
WHAT ABOUT MINOR AILMENT NURSES
IN PHARMACIES WITH OPEN ACCEESS TO
LOCAL GP SURGERIES?
I.T.
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NOT FOR DATA COLLECTION BUT TO
SECURELY SHARE PATIENT INFORMATION
BETWEEN CLINICIANS
I.H.R.(INDIVIDUAL HEALTH RECORDS)
THE MEDIA
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A LOT TO ANSWER FOR !!
USEFUL COMMUNICATION TOOL
VIPEROUS – QUICK TO BITE,VENOMOUS
AND NOT CHOOSEY ABOUT PREY !
COZY WITH WAST AT PRESENT - BUT
BEWARE – KNOWN TO TURN ON THEIR
YOUNG !
PATIENTS
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CHANGING DEMOGRAPHICS HAS MADE
THEM VULNERABLE
NO LONGER SURE WHERE TO GO FOR
HELP
WHY DO SO FEW ACCESS NHSD?
NEED GUIDANCE FROM W.A.G. AND
PROFESSIONALS BEFORE THE EVENT
SIGNPOSTING
DR. FINDLAY’S CASEBOOK
10
9
8
7
6
5
4
3
2
1
0
TOTAL
COMMUNITY
CARE
AMBULANCE
SERVICE ETC
HOSPITAL
CARE
FAMILY
HEALTH CARE
GPs
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LOTS OF GOOD GPs - SOME BAD GPs
ADEPT AT JUMPING THROUGH W.A.G. HOOPS
ACCESS STILL A PROBLEM IN REALITY
LACK OF CAPACITY AN ISSUE – SMALL
INCREASE IN GPs IN WALES
LACK OF MINOR ILLNESS NURSE
PRACTITIONERS
TARGETS AND C.D.M. LIMIT U.C. CAPACITY
GPs
OUR ROLE HAS BEEN CHANGED BY W.A.G.
WE ARE NO LONGER DOCTORS OF
ILLNESS WE HAVE BECOME MANAGERS OF
WELLNESS
OTHERS
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SOLICITORSTHE AMERICANISATION OF MEDICAL LITIGATION IS
IMPACTING ON U.C. MANAGEMENT.
GPs ADEPT AT MANAGING RISK BUT BECOMING
MORE DEFENSIVE MEDICO-LEGALLY? REASON FOR GP ADMISSIONS INCREASING- JUST
LIKE CONSULTANTS IN A+E/AMU ADMITTING TO
DECIDE NOT DECIDE TO ADMIT- SO PUTTING
FURTHER PRESSURE ON THE SYSTEM
$6,000,000 QUESTION
HOW?
INDUSTRIAL MODEL OF CARE
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INPUT
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PRE –HOSPITAL
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THROUGHPUT
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INPATIENT
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OUTPUT
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DISCHARGE
PRIMARY CARE TEAM
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EXPERIENCE
GENERALIST SKILLS
STABILITY
ADAPTABILITY
COMMUNICATORS
VALUED
GPs IN A+E / U.C. - FUTURE
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TRAINING -? GPWSI
SINGLE FRONT DOOR
I.H.R.
LINKED I.T.
ACCESS TO IN-HOURS APPOINTMENTS
ACCESS TO BOOK IN-HOURS SERVICES
PRIMARY CARE ROLE : IN-HOURS
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INCREASE NUMBERS OF MINOR ILLNESS
TRAINED NURSES TO RELEASE GPs TO DEAL
WITH MORE U.C. CASES IN-HOURS
TRAIN RECEPTIONISTS TO FIELD CALLS MORE
APPROPRIATELY – PROTOCOLS
FACILITATE CONTACT WITH OTHER TEAMS –
LESS “US AND THEM”
EXPAND COMMUNITY GP BEDS
EXTENDED OPENING
GPs IN A+E / UNSCHEDULED CARE CENTRES
The Edinburgh model
Alastair Crosswaite
[email protected]
CHANGE OF PHILOSOPHY
TEAMWORK
CO-LOCATION
GP BEDS @ DGH
PRIMARY CARE PHYSICIANS
Daily clinical sessions 5/7
Experienced generalist with primary care sensibilities in acute
secondary care setting
Working at the primary/secondary care interface to manage
patients in both directions
LOCATION, LOCATION
LOCATION …….
Community
Primary Care
Out of Hours
Combined Assessment
Medical GP referrals
Surgical GP + A/E
22000
Home
Specialty Wards
Diagnostics
Critical Care
A/E
72 000
Rehabilitation
The Acute GP Service
(AGPS)
Challenging Traditional Non-Elective Care
Main Objectives
To Transform traditional ways of working:
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Challenging existing pathways of care, and ways of thinking
about care
Creating effective clinician to clinician dialogue
Highlighting the need for inter-dependence of all services that
support patients
Operational Overview
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Monday- Friday 9am – 7pm
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Covering and working from AMU
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Take all community telephone referrals for
adult medical admissions, as well as providing advice to
community based colleagues
Onsite advice/opinion to secondary care
colleagues
Outcomes : April 2007 – March 2008
Total Days of Service:
222
Total Calls taken:
3170
Total Patients under AGPS Care:
989
Admissions avoided
899 (28%)
AGPS OPDs
845 (27%)
PRIMARY CARE CAPACITY?
ZERO !!!!!
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