Transcript Implementing and evaluating integrated services in the

Levers for change in general practice and
primary care: setting the context
Dr Rebecca Rosen
Senior Fellow
The Nuffield Trust
General Practitioner
South East London
November 6th 2014
© Nuffield Trust
13/11/2013
Overview
1.
What changes are we trying to achieve?
2.
Brief overview of recent levers for change
3.
Aims of the workshop
© Nuffield Trust
Hardly a week goes by….
© Nuffield Trust
What are we trying to achieve?...
London commissioning framework for primary care transformation
• Accessible care
•
•
•
Extended hours
Underpinned by technology
Adapted to the needs and preferences of different patient
• Proactive care
•
•
•
Supporting health and wellbeing
Building capacity for self care
Developing community resilience
• Coordinated care
•
•
Continuity for complexity
Care planning and multidisciplinary working for selected patients
© Nuffield Trust
What are we trying to achieve?...
•
•
•
•
•
Large scale primary care organisations
Various forms emerging (super practices, networks, federations, multisite providers)
Broadening scope of services offered
Infrastructure for economies of scale and quality improvement
Focus for integrated provision
© Nuffield Trust
Super-practices
Networks
Multi-site operators
Federations
Underpinned by new ‘design principles’
Recasting the relationship between patients and clinicians
•
Access to a senior clinician as early as possible in any contact with the practice.
•
Access to primary care advice and support underpinned by systematic use of technology.
•
Patients have minimum number of separate visits/consultations.
•
Patients offered continuity where this is important, and access at the right time when required
•
Care is proactive and population-based where possible, especially for long-term conditions
•
Care for frail people with multi-morbidity is patient-centred/tailored to individual need
•
GPs work as part of a multi-disciplinary team within and beyond the practice
•
Where possible, patients are supported to identify their own goals / manage their own condition and care
•
Organisational change in GP practices: access to diagnostics, integrated electronic records
For further detail see Securing the Future of General Practice. Nuffield Trust 2013
© Nuffield Trust
Similar changes/challenges in other professional sectors
• Reorganisation into chains
• Standardisation of
professional practice
• More measurement and
transparency
• Recasting professional
standards and ethics
(banking)
© Nuffield Trust
Transforming the nature and role of general practice
Changes in scale and content of GP work
Recasting relationships between general practice
and other services
Extending GP roles in integrated care pathways
and community based care
But also:
‘Preserving the art of general practice’
Balancing patient relationship with measurement
and reporting
Re-professionalisation and higher trust ?
© Nuffield Trust
Brief overview of recent levers for change
Financial micro-incentives:
•
•
Quality and Outcomes Framework
Local enhanced services / commissioning incentive schemes
Contracts and contracting:
•
•
Contracts for GPSI and integrated services
Practice based commissioning – changed referrals, prescribing
Peer learning and influence:
•
Review by peers of clinical performance data and other areas of clinical practice
•
National collaboratives
Redesign of organisational culture/re-professionalisation:
•
Peer led change
•
Strengthening sense of professionalism and accountability for good outcomes
Structure and process (barriers)
•
Referral management centers etc
© Nuffield Trust
Financial micro-incentives as the dominant paradigm ?
Multiple financial micro-incentives:
• QOF targets
• PMS contract KPIs
• Local contract KPIs
• National enhanced services
• Local commissioning incentives schemes
© Nuffield Trust
Aim of today’s workshop
To examine the range of methods currently used to
change and improve general practice and primary
care and to consider which method or combination of
methods is most likely to deliver sustainable,
transformational change; better outcomes and better
patient experience of care.
© Nuffield Trust
How do you change GP behaviour?
• Better patient outcomes
• Better working day
• Better income
• Peer recognition
Dr Larry Casalino
© Nuffield Trust