Empowering gps to work collectively to improve patient care


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Empowering GPs to work collectively to improve patient care - Dr Richard Healicon and Mel Varvel
Free GRASP tools for GPs for atrial fibrillation, heart failure and COPD
Presentation from the Health and Care Innovation Expo 2014

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Empowering gps to work collectively to improve patient care

  1. 1. Empowering GPs to Work Collectively to Improve Patient Care Mel Varvel Dr Richard Healicon NHS Improving Quality
  2. 2. Introduction • • • • • • NHS Improving Quality An ambitious call to action System levers and drivers Roles and responsibilities Carrots and sticks The GRASP Approach
  3. 3. NHS Improving Quality • Set up from 1 April 2013 and hosted by NHS England • Improving health outcomes across England by providing improvement and change expertise • An evidence-based organisation that is aligned to the current needs and challenges of the NHS • Builds on the wealth of knowledge, expertise and experience that has gone before • The ‘go to’ organisation leading improvement in England • Working with partners in design and delivery across the service
  4. 4. Five Transformational Change Programmes • Living longer lives • Promoting and enabling integrated care and support • 7 day services • Patient safety • Valuing patient experience
  5. 5. Living Longer Lives • Supporting implementation of the CVD Outcomes Strategy (and NHS Health Check) • Raising public awareness of symptoms and supporting early diagnosis of disease • Engaging with clinicians and primary care in the nation’s biggest killers
  6. 6. An Ambitious Call to Action
  7. 7. System Levers and Drivers • • • • • GMS Contract Enhanced service contracts (DES) Extended service contracts (LES) Quality and Outcomes Framework From April 2014 – Named, accountable GP for >75s – Greater role in reducing avoidable emergency admissions • CCG Outcomes Indicator Set (CCG OIS)
  8. 8. Roles and Responsibilities Flow of funding and contracting in general practice under current system Commissioning bodies NHS England Clinical Commissioning Groups Core Contracts Funding streams and contracts Quality and Outcomes Framework (QOF) GP practices are rewarded according to their performance against a number of indicators Communitybased services (formerly Local Enhanced Services) Public Health Includes things like screening and immunisation from April 2014 Voluntary/ additional contracts GPs supply services to the NHS via three contracting routes. • GMS (nationally agreed) • PMS (locally agreed) • APMS (locally agreed) Local Authorities Enhanced Services Payments currently linked to extended hours of service provision, minor surgery and other enhanced clinical services GP Provider organisations (almost all payments go to the GP provider organisation and not individual GPs)
  9. 9. Carrots and Sticks
  10. 10. From Compliance to Commitment
  11. 11. The GRASP Approach • Simple audit tool to improve the management of a number of LTCs • Collective goal setting – no minimum performance standard • Bottom up approach – No hierarchical control • Voluntary participation – Not delivered through formal control mechs • Delivery through shared commitment – Not performance managed • A vehicle for engagement and improvement – GPs firmly in the driving seat
  12. 12. The GRASP Suite of Audit Tools Dr Richard Healicon Programme Delivery Lead, Living Longer Lives Mel Varvel Improvement Manager, Living Longer Lives
  13. 13. Outline • • • • • • • Introduction- GRASP Suite Focus on GRASP-AF Guidance on management of stroke risk in AF Tools to help: GRASP-AF and CHART Online Other toolkits Summary How to access the GRASP Suite
  14. 14. GRASP toolkits • • • • • • • Free primary care audit tools AF, COPD and HF Aligned to NICE/ ESC guidance Each has a case finder Compatible with all GP systems in England Stand alone (patient identifiable) CHART Online (anonymised data)
  15. 15. GRASP-AF • Guidance on Risk Assessment and Stroke Prevention in AF
  16. 16. Stroke is a frequent complication of AF • Stroke is the leading complication of AF • Patients with AF have a five-fold higher stroke risk than those without AF • Without preventive treatment, each year approximately 1 in 20 patients (5%) with AF will have a stroke • It is estimated that 15% of all strokes are caused by AF and that 12,500 strokes per year in England are directly attributable to AF
  17. 17. Stroke is a serious complication of AF • Stroke in AF is associated with a heavy burden of morbidity and mortality • AF related stroke is usually more severe than stroke due to other causes • Compared with other stroke patients, those with AF are more likely to: – Have cortical deficit (e.g. aphasia), severe limb weakness and diminished alertness, and be bedridden on admission – Have longer in-hospital stay with a lower rate of discharge to their own home • The mortality rate for patients with AF is double that in people with normal heart rhythm
  18. 18. Stroke Risk Stratification
  19. 19. Stroke risk in AF: CHADS2
  20. 20. Stroke risk in AF: CHA2DS2VASc
  21. 21. Stroke risk in AF
  22. 22. ESC Guidelines Focussed Update 2012
  23. 23. GRASP-AF • • • • One of three free audit tools developed by NHS IQ and PRIMIS Case Finder Identifies patients with a history of atrial fibrillation Searches for co-morbidities and calculates both a CHADS2 and CHA2DS2-VASc score • Searches for current medication- warfarin, aspirin or newer oral anticoagulant • Searches for recorded reasons for NOT treating with warfarin • Gives a simple alert for those at high risk and not on warfarin or newer oral anticoagulant
  24. 24. The GRASP-AF toolkit in action
  25. 25. CHART Online • Voluntary upload of data to CHART online • Web based analysis tool with a variety of comparative viewing options available • Secure and restricted access • For both primary care staff and commissioners
  26. 26. Clarification about security • Only anonymised patient level data is uploaded and that this is transmitted and stored securely • Viewing data in CHART Online is restricted to people registered on the PRIMIS Profile Centre who are validated by either PRIMIS or NHS Improving Quality • Users who are validated by PRIMIS or NHS Improving Quality will only be able to view a Practice's national code if given specific permission by the Practice
  27. 27. CHART Online data- management September 2013: 183,334 patients with a CHADS2≥2 in those 2,515 practices: • • • • 48.4% patients on oral anticoagulation (OAC) alone 8.4% patients on OAC and aspirin 34.5% patients on aspirin alone 8.7% are not on either Of those 79,082 patients not on OAC: • • • 9.8% OAC declined 3.6% contraindicated 86.6% no reason given
  28. 28. Chart Online • • • • Benchmark own practice against others in CCG Benchmark CCG against others in SCN/ National Practices control who sees their national identifier Facility to email all in CCG to seek permission for this
  29. 29. CHART Online • Opportunity for – GP/ Practice level audit- revalidation – CCG/ SCN level audit- improve together – Data sharing with SCNs/ AHSNs
  30. 30. Current Issues • Data sharing – GPs are data controllers – How to share more widely- CCGs, SCNs, AHSNs, NHS IQ
  31. 31. GRASP-COPD
  32. 32. GRASP-HF
  33. 33. Summary • Almost one third of GP practices in England using GRASP-AF and uploading data to CHART Online • GRASP-AF is improving the way stroke risk in AF is managed; changes are small but potential impact is great • NHS Improving Quality wants to build on the success of GRASP-AF by developing a ‘suite’ of similar tools for other conditions. • GRASP-COPD is now available. • GRASP-HF is now available.
  34. 34. Getting GRASP
  35. 35. Getting GRASP
  36. 36. Reducing premature mortality: Supporting CCGs • • • • Webpage resources & PDF version ‘Our Ambition to Reduce Premature Mortality’ now on NHS England website. Produced with partner organisations (NHS IQ, PHE, Commissioning Assembly quality working group) Information on prevention, earlier diagnosis, case finding - including GRASP tools - & interventions likely to have greatest impact on reducing premature mortality. Further development of resources planned for April/May See www.england.nhs.uk/premature- mortality/
  37. 37. @NHSIQ #GRASP_suite Visit us on Stand C20 enquiries@nhsiq.nhs.uk www.nhsiq.nhs.uk Improving health outcomes across England by providing improvement and change expertise.