Your SlideShare is downloading. ×
S141 – Day 1 – 1545 – Closing the gap between primary and secondary care
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

S141 – Day 1 – 1545 – Closing the gap between primary and secondary care

317
views

Published on

Health and Care Innovation Expo 2014, Pop-up University …

Health and Care Innovation Expo 2014, Pop-up University

S141 – Day 1 – 1545 – Closing the gap between primary and secondary care

Bridget Fletcher
Dr Richard Pope

#Expo14NHS

Published in: Health & Medicine

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
317
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. closing the gap between primary & secondary care Bridget Fletcher, Chief Executive, Airedale NHS FT Richard Pope, Hon Consultant Physician, Airedale NHS FT Colin Renwick, Chair, Airedale Wharfedale and Craven CCG
  • 2. Is there a Gap between primary and secondary care? Gap…what gap? Is there a gap between primary & secondary care?
  • 3. Through their eyes… “… I saw 3 different doctors in as many weeks and had to retell my story each time…” “…communicate with everyone who supports me…” “…the systems work for systems not for individuals…” “…catch me on a low day and support me…” “…no one asked me what was important to me…” “…clinical priorities may not be my priorities “…I don’t want to wait for a doctors appointment , I want to talk to someone immediately…” “…need some way of checking where my prescription is and tracking its progress…” “…have to keep repeating my story…”
  • 4. stressed clinical staff
  • 5. The need for change The need for change is compelling – the standard drivers include…. cost:  an estimated 20% of healthcare spend is wasted on overuse, misuse or underuse of care  72% of discretionary spend is controlled by the Doctor’s pen  unprecedented efficiency challenges
  • 6. The need for change The need for change is compelling – the standard drivers include…. complexity:  multimorbidity, including cognitive impairment, has become the “norm”  demand, particularly in the LTC area, is increasing rapidly
  • 7. The need for change The need for change is compelling – the standard drivers include…. quality:  the delivery models of the past are in many cases no longer fit for purpose  measurement of quality is by silo – not really by users‟ experience
  • 8. The need for change inertia: failure to recognise these issues underpins much of the “aversion to change” in the NHS
  • 9. close - or FILL - the gap?
  • 10. Our Vision
  • 11. The guiding principle of our shared vision “ whilst commissioners and providers are responsible for whole populations, it will be our shared focus on meeting individual need that will define us. This individual focus lies at the very heart of the delivery of „Right Care‟….”
  • 12. The dialogue Locally – series of very constructive meetings Primary:Secondary care Enthusiasm Sense of urgency and ability to move Key element – Shared EHR as a tool for transformation generate the win:win e-discharge e-prescribing MSK pathways across org boundaries GUM Community services…..
  • 13. Is this enough? ….the ‘aggregation of marginal gains’. Put simply….how small improvements in a number of different aspects of what we do can have a huge impact to the overall performance….
  • 14. e-Consultation use May 2010 to March 2013 - Bradford , Dr J Connolly 0 20 40 60 80 100 120 140 May-10 Jun Jul Aug Sep Oct Nov Dec Jan-11 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan-12 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan-13 Feb Mar Rheumatology Nephrology Haematology Hepatology Endocrinology Diabetes Cardiology
  • 15. Immediate access to…… immediate access
  • 16. teleconsultation
  • 17. in primary care
  • 18. Care Homes - summary 0 100 200 300 400 500 600 700 Acute Admissions 1 Year Prior to Deployment of Telemedicine Acute Admissions 1 Year Post Deployment of Telemedicine
  • 19. The guiding principle of our shared vision “ whilst commissioners and providers are responsible for whole populations, it will be our shared focus on meeting individual need that will define us. This individual focus lies at the very heart of the delivery of „Right Care‟….”
  • 20. how will we know what people want/need – unless they tell us…
  • 21. The person orchestrating their own care with clinicians working by exception
  • 22. Closing the gap: where to start? Need to secure GP and consultant confidence in the benefits of collaboration A clear articulation of what the benefits (and risks) of collaboration are? Mutual understanding and respect on both „sides‟ Focus on what is (should be!) of importance to clinicians: - getting the best clinical outcomes for our patients (no brainer) - getting the best value-based healthcare / use of resource in AWC)
  • 23. Closing the gap: where to start Changing behaviours – taking responsibility for system resource – an OD Piece: Hospital – ‘do I really need to admit’ – do I know what’s available in primary care can I be bothered to pick up the ‘phone (use SystmOne!!) to discuss with my primary care partner GP – ‘do I really need to refer’ – could I use an alternative – can I be bothered to spend the time finding that alternative”
  • 24. Clinical service collaboration „gap‟ interface AWC Federations / practices Delivering primary care Interface (gap) opportunities: Musculoskeletal Genitourinary medicine Substance misuse Community services What else? ANHSFT Delivering secondary care Our shared Right Care STRATEGIC AIM: to blur the care delivery boundaries further and this gap to narrow? Patient experience across AWC becomes SEAMLESS
  • 25. Filling the Gap: Health Economy Clinical Boards Membership: GPs/Consultants/Public Health Physicians/Lay Focus on high impact / high spend (PHE data) / quality issues Each Board co-designs / agree pathways and resource utilisation ?Cancer services ?LTC / multi-morbidity ?Vascular (CVS/Stroke/DM) Core outputs: Patient Experience & evidence of QI
  • 26. Filling the Gap What does this mean? Hospital staff in primary care and vice versa. Locally designed and owned approaches Rich Clinical Data will facilitate better clinical decision making There must be (effectively) a “single” patient record Our Patients will make a huge contribution to the signalling that triggers response from the system
  • 27. Filling the Gap What does this mean? Technology, not transport, will bring teams together Pathways will be compressed. This will decrease, not increase, work in the system Clinicians’ working day will look very different Our Patients will have a (much) better experience of care Costs of care delivery, particularly for LTCs, will reduce
  • 28. Filling the Gap continued In order to work at real scale  What will the organisational forms look like ?  What will commissioning look like?  What will payment systems need to look like?