Transcript BHIVA standards project - UK-CAB

DISCLAIMER
Please note this presentation outlines the
personal opinions of Hilary Curtis.
The views expressed are not, nor should they be
construed as, endorsed by or representative of
the British HIV Association (BHIVA).
R. James - UK-CAB Steering Group
© hilarycurtis.com 24 November 2006
BHIVA standards
project
Hilary Curtis 24/11/06
Outline
The context of change in:
 NHS structure and organisation
 Models of care
 Medical education and certification
What do we mean by quality in health care?
The BHIVA draft standards
Where do we go next?
© hilarycurtis.com 24 November 2006
The changing NHS
Diversification of providers – market entry:
 GUM perceived as easy to outsource
 Move towards community provision
 Acute sector re-configuration
 Payment by results, but “unbundling”
possible
 ?Service integration by foundation trusts.
© hilarycurtis.com 24 November 2006
The changing NHS, cont.
Commissioning of specialised services:
 SHAs must run Specialised Commissioning
Groups
 PCTs must take part
 Group decisions binding on PCTs
 Group can designate providers
 Definition set under review.
© hilarycurtis.com 24 November 2006
Model of care
Case management for chronic disease:
 Pressure to reduce unplanned hospital
admissions
 Mainly for elderly with multiple health
problems
 GP and community matron roles
 Multidisciplinary, coordinated specialist care
 Self-management and expert patients.
© hilarycurtis.com 24 November 2006
Medical education and
certification
Modernising Medical Careers:
 HIV medicine not a recognised specialty
 Shorter, structured post-graduate training
 Competency based
 Requirements currently uncertain.
Re-certification of specialists:
 At least every five years
 Based on what individual doctor does.
© hilarycurtis.com 24 November 2006
Elements of quality
Evidence-based practice/clinical guidelines
Advanced facilities, eg diagnostics, ITU
Expertise:
 Range of skills, experience for varying patient needs
 Going beyond guidelines
 Avoiding professional isolation
Accountability and responsiveness:
 Patient choice
 Patient involvement
 Partnership.
© hilarycurtis.com 24 November 2006
The BHIVA standards
Concerns about:
 Inpatient care arrangements
 Future of outpatient care
 Adapting the chronic disease model
Historical baggage:
 Record-keeping and communication
 Late diagnosis/under-use of HIV testing by
generalists.
© hilarycurtis.com 24 November 2006
Next steps



Build on existing networks and get
commissioner buy-in
Accept rationalisation of inpatient care
Keep HIV as a specialised service.
© hilarycurtis.com 24 November 2006