Transcript Template One - NHS Grampian

Aberdeen City Community
Cardiology Planning Day
Where we need to get to
by 2011
Clare Smith
Unit Operational Manager, Cardiac
Aberdeen City Community
Cardiology Planning Day
• 18 Weeks RTT- Why?
• 18 weeks – what is counted and
what isn’t?
• Where are we now?
• What do we need to do to move
forward?
Aberdeen City Community
Cardiology Planning Day
Waiting Times= Acute care
•
The Scottish Government has set out the vision for a stronger NHS
in Scotland that will make better use of NHS capacity to deliver a
better deal for patients. A major element in achieving this vision will
be a new national waiting time standard:
•
From December 2011, 18 weeks will become the maximum wait
for treatment following referral by a GP for non-urgent
patients.
“Better Health, Better Care” (Scottish Government, December
2007)
•
•
The 18 weeks Referral to Treatment (RTT) Standard is an integral
element of the strategic objectives set by the Scottish Government
that will structure decision-making and give clear focus to delivering
better health services for the people of Scotland.
Aberdeen City Community
Cardiology Planning Day
Why?
• The end of queuing as a rationing
mechanism
• The end of inequitable service
• The end of an ever distancing tail
• The end of the anxiety and worry
which goes with waiting
• The end of stage of treatment
guarantees
Aberdeen City Community
Cardiology Planning Day
What is Counted and What Isn’t?
The clock starts for a RTT period on
the date of receipt of referral to:
• a consultant-led service
• a referral management centre
Aberdeen City Community
Cardiology Planning Day
Definitions
A Consultant Led Service is:
• Where a Consultant retains overall clinical responsibility for the service, care,
professional team or treatment. This is applicable whether it be in the Acute or
Primary Care setting
• The Consultant will not necessarily be physically present for each consultant
led activity.
• Diagnostics are included within this provided the patient will be assessed and
might, if appropriate, be treated by a medical or surgical consultant-led
service before responsibility is transferred back to the referring health
professional. This is also known as “straight-to-test”
• Direct access referrals to diagnostic services are excluded if
the referral is not part of a straight-to-test referral pathway.
Referral Management Centre is:
• A referral management centre is any service that incorporates any
intermediate levels of triage and assessment between traditional Primary Care
and Secondary Care.
Aberdeen City Community
Cardiology Planning Day
Case Study 1
• Mrs. T was referred to the Dr Hannah’s consultant led CP clinic at her local hospital in
Peterhead. At the first outpatient appointment, Mrs. T was examined by the GPSI who
diagnosed angina and commenced medical management.
• Although Mrs. T saw a GPSI rather than a Consultant, her 18 weeks RTT clock still
started on the day that the hospital received the referral. This is because the clinic was
running as an independent chest pain clinic as part of the Andrew’s team.
Case Study 2
• Mrs V visited her GP complaining of breathlessness and palpitations. Her GP decided to
refer her for an echocardiogram at the local hospital cardiology department to help inform
her of the best way to manage her condition.
• No 18 weeks RTT clock has started, as the GP has made a referral for diagnostic test
with the intention that the responsibility for the patient remains with the GP: there is no
immediate intention for the patient to go on to see a consultant-led service.
Case Study 3
• Mr G attended his GP complaining of chest pains. His GP referred Mr G to his local
hospital. All referrals are triaged by clinical and administrative staff in the Referral
Management Centre, who assessed the information contained in the referral document,
and passed the referral (as per agreed protocols) to the chest pain clinic in the
neighbouring hospital.
• Mr G’s RTT clock started when the referral was received by the Referral Management
Centre, even though the hospital did not receive the letter until three days later.
Aberdeen City Community
Cardiology Planning Day
What Does this Mean for Current
What does
this
mean for current
Services
in the
Community?
services in the Community?
• GPOA Echo = No waiting Times
• GPOA ETT = No Waiting Times
• GPOA Holter = No Waiting Times
• ARI and DAB GPSI CP Clinics = Waiting Times
• Consultant Community Clinics = Waiting Times
Aberdeen City Community
Cardiology Planning Day
Better Care Without Delay is about
adding value to the patient
journey and ensuring patients
access the appropriate Services
when they need to whether that be
in the Acute or Primary Care
setting.
Aberdeen City Cardiology
Planning Day
Where are we now?
12 Weeks Targets all DAB, ARI and Aberdeeshire met.
Aberdeen City Community
Cardiology Planning Day
Now
12 wks
Cardiology OPA
26 wks
16 wks
AG
Revascularisation
N.B. The RACPC Route is the same from AG onwards but has a
2 weeks appointment guarantee for the OPA.
Aberdeen City Community
Cardiology Planning Day
2011
<5 wks
Cardiology OPA
<9 wks
AG
<18 wks
Revascularisation
N.B. The RACPC Route is the same from AG onwards but has a
2 weeks appointment guarantee for the OPA.
Aberdeen City Community
Cardiology Planning Day
RACPC Review
• Revision of RACPC and roll out
across GP practices
• Clear referral routes
• Timeous access to RACPC
• Waiting Times
Aberdeen City Community
Cardiology Planning Day
Number of Weeks Waiting
ARI
Echo
General
GPOA
Echo
Holters
General
GPOA
Holter
GPOA
ETT
Echo
Gen
GPOA
Echo
Holters
Gen
GPOA
Holter
GPOA
ETT
6-7mths
28wks
2wks
8wks
15wks
________
768
50
88
138
_________
_______
_______
________
_______
2wks
9/10wks
DAB
16wks
INV
KCH
_______
PHD
TUR
Number of Patients on List
_______
_______
_
53
______
________
0
4wks
_______
_______
_
_______
_______
0
_______
_
________
________
9wks
_______
_______
_______
_______
23
_______
________
________
9wks
_______
19wks
1wk
_______
20
_______
20
2
N.B No Waiting Times are applied to ‘General’ Diagnostics but they are being monitored by the
Executive pending roll out.
Aberdeen City Community
Cardiology Planning Day
What do we need?
•
Better planning and scheduling of resources. (Readiness Assessment Tool)
•
Planned alternative referral and treatment routes that speed up access and
reduce waiting times allowing patients to be seen by the right person, in the
right place, at the right time. (Readiness Assessment Tool)
•
Centralised points of referral that minimise the number of queues and simplify
communications for patients, healthcare professionals and the administrative
and support teams. (Readiness Assessment Tool)
•
Clear rapid signalling processes in the system that can alert all teams involved
in a patient process about changes in service provision due to unforeseen
circumstances such as absence/illness or interruptions to normal service.
(Readiness Assessment Tool)
•
Improvements in queue management through pooled lists and streamlined
patient processes. (Readiness Assessment Tool)
Aberdeen City Community
Cardiology Planning Day
Patient Centered Service Review
Developing a Plan for Aberdeen City
•Community Cardiology i.e. shifting the balance of care out of the Acute
setting
•What does ‘Shifting the Balance of Care’ actually mean?
‘…improve the health of the people of Scotland by shifting the emphasis towards health
improvement, preventative medicine and more continuous care in the community.
…We aim to improve access to care and treatment through a general shift in the
location of services and care. For example, a wider range of diagnostic procedures and
specialist services are being embedded into communities through Community Health
Partnerships. We expect to see less acute hospital centred activity as we continue to
develop our community infrastructure and community hospitals. This will enable us to get
a better balance between planned and unscheduled care’ www.scotland.gov.uk
Aberdeen City Community
Cardiology Planning Day
Model of Care
One Size Does not Fit All
•Areas of commonality between Aberdeenshire and
Aberdeen City i.e. need for GPOA Echo and Holters
For Discussion
•Is the GPsWI model correct for a City Solution?
•Should Community Cardiology be provided by Speciality
Drs within the Community?
•How do the costs stand up?
Aberdeen City Community
Cardiology Planning Day
Other Considerations for Discussion
Patient
Considerations
Resources
GPOA Echo
GPOA Holter
Chest Pain NP
Other Cardiology NP
All Re-referrals
Criteria
Competencies
Accountability
Patient Focused?
Appropriateness
Frequency
Waiting Times
Referral Systems
Training
Physiologists
Cardiologists
GPSWI
Registrars
Specialist Drs
Cross Cover
Admin
IT
Accommodation
Current Service levels
Nurse-Led