Dr Jack Nagle, CEO, Alpha Healthcare
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Dr Jack Nagle, CEO, Alpha Healthcare



Primary Care Centre Stage - Better Outcomes with Scarce Resources

Primary Care Centre Stage - Better Outcomes with Scarce Resources



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Dr Jack Nagle, CEO, Alpha Healthcare Dr Jack Nagle, CEO, Alpha Healthcare Presentation Transcript

  • 2nd National primary Care Conference MPHC 14 November 2012Primary Care Centre Stage – Better Outcomes with Scarce Resources Jack Nagle, CEO, APC
  • Outline• Case for Primary Care• Delivery Solutions – Mechanism – Methods – Example
  • Alpha Background• Founded 2003 – Ireland & UK• Models for Practice Management & Primary Care Centre Development• Gold Standard systems & methodologies for General practice• TQM – total quality management• Worked in more that 100 + practices• Developed primary care centres,• Strategic partner of the NHS Alliance• Compliance to Care Quality Commission regulations© Alpha Healthcare Ltd, Confidential
  • Change is happening..© Alpha Healthcare Ltd, Confidential
  • IMAGINE ! Imagine if every patient, who really needed a bed in hospital had a bed available,Imagine if many more people could be effectively treated for chronic disease in their local communities, Imagine if these two events were connected and Cost LESS For BETTER health outcomes Imagine…. PRIMARY CARE See case studies and info at www.primarycare.ie
  • Chronic Disease Management – Over 25% of Irish population suffer from chronic diseases – these chronic diseases account for 80% of all healthcare costs, – 18 Chronic diseases account for 80% of hospital based expenditure – 10% for diabetes alone, – CD accounts for 80% of GP consultations, 60% of hospital bed days & 2/3rds of emergency medical admissions to hospitals – Best practice for management of chronic diseases involves intervening with the patient when they are unwell the 1st time – this is known as CDM or chronic disease management – CDM is the foundation of the most effective healthcare systems in the world - Canada, Australia and New ZealandConfidential
  • Quality & TQM ?• Quality – is it going to really impact on general practice?• A philosophy! – Focus on the patient, – Focus on preventing problems rather than having to fix them, – Relentlessly eliminating waste and inefficiencies, – Involving all staff, – Benchmarking and sharing best practice, – Monitoring and reviewing performance,• Key Enabler for : – Efficiency improvements
  • SERVICE DELIVERYApproach ( UK):Commissioning : - Process by which the health needs of the local population are identified, priorities for investment are set and appropriate services are purchased and evaluated - National and Local incentives to promoteProvider: - A health care provider is a legal entity, or a sub-set of a legal entity, which may provide healthcare under NHS Service Agreements - GP practice, NHS trust, Independent provider  provider organisationsCompetition: - Efficiency & value for money ? - Regulation – Standards & QualityI
  • Care Quality Commission – UKHIQA Standards for Primary Care ? CQCs Essential Quality & Safety Standards Practices must meet these standards: •OUTCOME 1: Regulation 15: Respecting & Involving people who use the services Involvement & Information •OUTCOME 2: Consent to care & treatment Personalised Care Treatment •OUTCOME 4: Care & welfare of people use use the services •OUTCOME 5: Meeting nutritional needs & Support •OUTCOME 6: Co operating with other providers •OUTCOME 7: Safeguarding people who use services from abuse •OUTCOME 8: Cleanliness & Infection Control Safeguarding & Safety •OUTCOME 9: Management of medicines •OUTCOME 10: Safety & Suitability of premises •OUTCOME 11: Safety, availability and suitability of equipment Suitability of staffing & •OUTCOME 12: Requirements relating to workers •OUTCOME 13: Staffing Suitability of Management •OUTCOME 14: Supporting workers •OUTCOME 16: Assessing & monitoring the quality of service provision Quality & Management •OUTCOME 17: Complaints •OUTCOME 21: Records
  • Case Study :TQM to Increase Practice Capacity • Initial Consultation Rate = 8.17; • After changes = 6.41 • 22% Improvement!
  • Case Study - NHS HEALTHCHECKSAim:• Deliver cardio-vascular risk assessment to the eligible population within 5 years• Assess 20% pa,• Within general practice – reduce variability in levels of delivery,Approach:• Local Enhanced Service to encourage practice involvement,• Improved patient care,• Invite patients & do detailed health check risk assessment• Communicate risk to patients & treat,• Management in line with National Best Practice & NICE Guidance• Payment to practices based on outcomesISO 9001 2008
  • Case Study - NHS HEALTHCHECKSGoals for NHS Health checks at Medical Practice• Suggestions from feedback session:• Phase 1 3 sessions/wk -> 6 sessions w/k 75 a month -> 150 month• Phase 2 6 sessions/wk -> 12 sessions wk 150 a month -> 300 month• Value of Smoking Cessation -> NHS Health check• Some patients for better Health Check• Use some time from Better Health Clinics to NHS Health check• Other “opportunistic” time to do NHS Health check• Temporary capacity available from Diabetic Clinic• Dressings – takes dedicated nurse time• Travel Vaccination Time – seasonal (some time availability)• Possibility of HCA doing NHS Health checksISO 9001 2008
  • Case Study - NHS HEALTHCHECKS Macro Overview of Current Nursing Activity Admin Practice Nurse 2 session/ week Clinics 10 /week Healthcare Assistant 16/week Baby Nurse Practce Immunisations 4/week 1.5/week Coils & Minor Well Women Surgery 5/week 2 session /week Diabetic 3/week Smoking 15/wk NHS Healthcheck 3/week Travel Clinic 1/week Practice Nurse Better Health Messages 12/week 1/2 session/ weekISO 9001 2008
  • Case Study - NHS HEALTHCHECKS 160 NHS HEALTHCHECKS - MONTHLY LEVELS 140N 120oP 100er Total 80 MaleM Femaleo 60nt 40h 20 0 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12ISO 9001 2008
  • Recap• Significant change happening within healthcare,• Primary Care – opportunities• “More from less” through TQM! Q&A