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PRIMIS 23rd April 2002Metropole Birmingham

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Primary Care

The changing future

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What will change?

• What we do

• Who we work with

• How we plan, develop and deliver services

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What will change?

• What we do

• Who we work with

• How we plan, develop and deliver services

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The Concept of MigrationV

olu

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f Activ

ity

Dista

nce

HomePracticeLocalityDGHSub Regional

RegionalSupra Regional

National PCT

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What will change?

• What we do

• Who we work with

• How we plan, develop and deliver services

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Partnerships

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Primary

Care

Secondary

Care

Social

Services

Planning for change

Intermediate care

Operational Strategic

Referral and discharge protocols

Maximising independence

Discharges and delayed discharges

Balancing capacity and

demand

Throughput planning and

admission prevention

Health promotion and

disease prevention

Integrated service

planning and delivery

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What will change?

• What we do

• Who we work with

• How we plan, develop and deliver services

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KEY WORDS

Prio

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Quality

Access

Equity

Demand

Supply

Modernisation

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Demand Capacity

Met need

Unmet need

Service demand and capacity

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Demand management?

The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

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Demand management?

The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

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Demand management?

The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

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Demand management?

The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

Triage for primary care

Prevention

Self-care

Community multidisciplinary teams - care at home

GP booking schemes

NICE referral guidelines

Priority scoring systems

Form referral letters

Direct booking at O/P appointments

Nurse led pre-assessment clinics

Clinics outside normal working hours

Consultant out-reach clinics

GP clinical assistants in O/P

PCT held waiting lists

Waiting list validation Facilitated early discharge

Intermediate care services

Hospital at home schemes

One stop rehab teams

Email consultation

Telemediine

GP specialists

Different use of GP time

Alternatives to GP

Systematic secondary prevention in primary care

Survey high DNA rates

Develop DNA policy

“Follow up” reviews

Primary based alternatives to hospital delivery

eg minor surgery

Triage for secondary care

PATIENT GP O/P REFERRAL O/P CLINIC WAITING LIST PROCEDURE DISCHARGE

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Demand Capacity

Met need

Unmet need

Adjusting referrals

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Demand Capacity

Met need

Unmet need

Adjusting referralsWhole HA

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5

10

15

20

25

ENT referrals to SUHT per 1000 patients

1:3 referrals may be avoidable

1:6 referrals may be avoidable with targeted GP education

110%

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Demand Capacity

Met need

Adjusting referralsWhole HA

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5

10

15

20

25

ENT referrals to SUHT per 1000 patients

1:3 referrals may be avoidable

1:6 referrals may be avoidable with targeted GP education

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Demand Capacity

Adjusting referralsWhole HA

0

5

10

15

20

25

ENT referrals to SUHT per 1000 patients

1:3 referrals may be avoidable

1:6 referrals may be avoidable with targeted GP education

Met need

Met Filled

Protocol driven referrals

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Demand Capacity

Met need

Unmet need

More than 10%imbalance

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Demand Capacity

Must have secondary care

Could be done in primary care

Adjusting services

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Demand Capacity

Must have secondary care

Could be done in primary care

Adjusting services

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Demand Capacity

Must have secondary care

Could be done in primary care

Adjusting services

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Demand Capacity

Must have secondary care

Could be done in primary care

Adjusting services

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Unmet need Capacity filled

Must have secondary care

Could be done in primary care

Adjusting services

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Demand Capacity

Must have secondary care

Could be done in primary care

Adjusting services

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Demand Capacity

Must have secondary care

Could be done in primary care

Adjusting services

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Demand Capacity

Must have secondary care

Could be done in primary care

Adjusting services

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Demand Capacity

Could be done in primary care

Adjusting services

Must have secondary care

Protocol driven referrals

orthop refs per 1000 ptnt

0

5

10

15

20

25

30

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

Practices anon

Act

ivit

y p

er

1000

pat

ien

ts

orthop refs per 1000 ptnt

0

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10

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Additions to orthop IP list per 1000 ptnt referrals not listsed per 1000 ptnt

% of IP additions to refs

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39

% of IP additions to refs

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Endoscopy services

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• Nuffield access equates to high referrals

• Average gastroscopy activity is 5.4 per 1000 population

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

1 3 5 7 9 11

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Nuffield Annual rate per 1000 pop

SUHT Annual rate per 1000 pop

Activity rates - City PCT

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Expectation of need• BSG Working Party Report 2001

City PCT Activity Activityper 1000 pop per 250000 pop 246000 pop % of expected

Diag Upper GI 10 - 15 (av 12) 3000 1334 44%Flex Sig 2.00 - 2.25 550 182 33%Colonoscopy 2.5 - 5.0 800 327 41%Colonoscopy Average to plan for 2250

ProcedureAverage Expected

Put these figures back to the upper GI diagnostic graph

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• Nuffield access equates to high referrals

• Average gastroscopy activity is 5.4 per 1000 population

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

1 3 5 7 9 11

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Nuffield Annual rate per 1000 pop

SUHT Annual rate per 1000 pop

Activity rates - City PCT

Average

Expected

Expected increase

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Expectation of need• BSG Working Party Report 2001

City PCT Activity Activityper 1000 pop per 250000 pop 246000 pop % of expected

Diag Upper GI 10 - 15 (av 12) 3000 1334 44%Flex Sig 2.00 - 2.25 550 182 33%Colonoscopy 2.5 - 5.0 800 327 41%Colonoscopy Average to plan for 2250

ProcedureAverage Expected

More procedures needed for City:Upper GI diag 1646Flex Sig 368Colonoscopy 473Total 2487 or 50 procedures per week

60 extra NHS procedures per week if include Nuffield activity27 MORE colonoscopies per week predicted by BSG

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Primary care managing throughput

• Delayed discharges (5/95)• Managing care• Managing waiting lists

– Clinically– Comparatively

Primary Care

Secondary Care

Referredpatients

Discharge

•Poor management of referred patients during wait

•Poor management of waiting lists

•Little co-ordination between various agencies

•Protracted affair

•Push system

•Delay inevitable

Reduced independence

Pre-intervention and reablementfunction

Primary Care

Secondary Care

INTERVENTION

Best independence

Reabling independence

Admission avoidance

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Balance

• Between demand and capacity

• Between availability and need

• Between needs and wants

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PRIMIS

23rd April 2002Metropole Birmingham