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Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
Quality, Innovation, Productivity and Prevention in Primary Care
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Quality, Innovation, Productivity and Prevention in Primary Care

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What do the Quality Ambitions mean for Primary Care? This session describes the ongoing innovative local improvements and national work with NHS …

What do the Quality Ambitions mean for Primary Care? This session describes the ongoing innovative local improvements and national work with NHS
Boards and Primary Care contractors to improve quality, efficiency and outcomes as well as the future plans for Primary Care.

Published in: Health & Medicine
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  • Specific changes made in response to things picked up during reviews: New protocol for recording adverse drug reactions Minimum annual FBC checks for all Warfarin patients Minimum annual Digoxin levels check Better systems for highlighting possible drug interactions when deciding the next dose of Warfarin Much better at coding relevant read codes Checking that locums are familiar with practice systems for Warfarin patients
  • Transport Inventory Motion ( > 1 GP visits patient in same street at same time) Waiting (no phlebotomist, so no results) Over Production (patients asking for all repeats at the same time, but not needed) Over Processing (patient gets unnecessary appointments with GP & PN for same episode of illness) Defects/ rework
  • Transcript

    • 1. DELIVERING QUALITY IN PRIMARY CARE: THE JOURNEY SO FAR <ul><li>Sir Lewis Ritchie </li></ul><ul><li>Chair </li></ul><ul><li>DQPC Steering Group </li></ul>
    • 2. THE JOURNEY SO FAR <ul><li>Reflecting back........... </li></ul>
    • 3. &nbsp;
    • 4. &nbsp;
    • 5. &nbsp;
    • 6. &nbsp;
    • 7. THE JOURNEY SO FAR <ul><li>Putting quality on the map........... </li></ul><ul><li>.......a national perspective....... </li></ul>
    • 8. &nbsp;
    • 9. The Journey So Far <ul><li>Delivering Quality in Primary Care (DQPC)..... </li></ul><ul><li>So: </li></ul><ul><li>What does the Quality Strategy mean for primary care? </li></ul><ul><li>What can primary care bring to the table? </li></ul>
    • 10. The Journey So Far <ul><li>A reminder of why we set out on this journey: </li></ul><ul><ul><ul><li>- Huge challenges facing NHS – demography (60% increase in over 75s over next 20 years), money: ring fencing but still £300 million efficiencies </li></ul></ul></ul>
    • 11. The Journey So Far <ul><li>A reminder of why we set out on this journey, cont… </li></ul><ul><ul><ul><li>Primary care a critical part of the solution. 90% of contacts; 23 million GP consultations; 1.9 million eye examinations; 91 million prescriptions dispensed, highly trained and capable resource...... </li></ul></ul></ul><ul><ul><ul><li>- But..... a sense of a dis‑engagement in recent years. So...need to re‑engage and re‑energise. </li></ul></ul></ul>
    • 12. 2010 engagement process <ul><li>6 regional events, 700 attendees from all PC players.... </li></ul><ul><li>Some key themes to emerge: </li></ul><ul><ul><ul><li>- Enthusiasm for the dialogue. Much scope for greater integration </li></ul></ul></ul><ul><ul><ul><li>- Finances a huge challenge but in every place people up for being part of the solution </li></ul></ul></ul><ul><ul><ul><li>Real issues around motivation but quality seen as potential to be a key motivator </li></ul></ul></ul>
    • 13. Follow up <ul><li>Determined there should be actions as result – leading to a: Delivering Quality in Primary Care Action Plan </li></ul><ul><li>DQPC Action Plan: not an exhaustive (and exhausting) list nor a rival to the QS. But key national actions which would make the biggest difference. </li></ul><ul><li>Overseen by DQPC Steering Group. Bookend event – today: do stay! – to keep us honest and help refresh the plan. </li></ul>
    • 14. Overarching themes <ul><li>Will mention a few of the actions, but first three very important overarching themes: </li></ul><ul><ul><ul><li>1 - Primary care&apos;s place at the table . Vital part of the solution. WHO has always said so. Increasingly recognised here </li></ul></ul></ul>
    • 15. Overarching themes <ul><ul><ul><li>Primary care&apos;s place at the table… </li></ul></ul></ul><ul><ul><ul><li>“ We need to make sure people are admitted to hospital only when it is not possible or appropriate to treat them in the community ... doing all of these things will result in changes in the pattern of acute care and.. fewer acute beds and, as long as it is appropriate and as a result of the kind of service change we want to see, we should see that as a positive” </li></ul></ul></ul><ul><ul><ul><li>(Cabinet Secretary to Parliament, June 2011) </li></ul></ul></ul>
    • 16. Overarching themes <ul><ul><ul><li>Primary care&apos;s place at the table… </li></ul></ul></ul><ul><ul><ul><li>Key part in the Health Boards’ annual review process. </li></ul></ul></ul><ul><ul><ul><li>Today’s PC events as integral part of annual NHS Scotland event. </li></ul></ul></ul>
    • 17. Overarching themes <ul><li>2 – Need for grown up relationship with all independent contractors : </li></ul><ul><li>For too long we’ve kept each other at arms length </li></ul><ul><li>Multi-professional Involvement in DQPC Steering Group, in individual actions and as day‑by‑day partners </li></ul>
    • 18. Overarching themes <ul><li>3 – The Leadership Imperative : </li></ul><ul><ul><ul><li>Visionary and vigilance </li></ul></ul></ul><ul><ul><ul><li>Enablement and encouragement </li></ul></ul></ul><ul><ul><ul><li>Courage and example </li></ul></ul></ul>
    • 19. What’s the bottom line? <ul><li>Actions set out in DQPC plan. Not list all now: a number, including local, will be showcased at 5.15pm </li></ul><ul><li>A few highlights: </li></ul><ul><ul><ul><li>- eye care integration : potential to revolutionise primary/secondary care link </li></ul></ul></ul><ul><ul><ul><li>prevention : Keep Well and Childsmile rolled out; £70m Change Fund </li></ul></ul></ul>
    • 20. What’s the bottom line? <ul><ul><ul><li>Highlights continued… </li></ul></ul></ul><ul><ul><ul><li>GP access : toolkit developed with profession </li></ul></ul></ul><ul><ul><ul><li>developing a HEAT target on timely, accurate info at the primary/secondary care interface </li></ul></ul></ul><ul><ul><ul><li>leadership : launch tomorrow of Strategic Clinical Leadership network; plus joint RCGP/ NES initiative on leadership in primary care </li></ul></ul></ul>
    • 21. What’s the bottom line? <ul><li>Looking forward to hearing your reactions on the journey so far and what lies ahead </li></ul><ul><li>Meanwhile: some more detail on 3 of the key areas of activity </li></ul><ul><ul><li>Primary /secondary care interface </li></ul></ul><ul><ul><li>Patient safety and </li></ul></ul><ul><ul><li>“ Productive General Practice” </li></ul></ul>
    • 22. WHATS GOING ON OUT THERE? PRIMARY CARE IN SCOTLAND DR SHEENA L MACDONALD Senior Medical Adviser Scottish Government
    • 23. The Complete Works of William Shakespeare (Abridged) By Adam Long, Daniel Singer and Jess Winfield Damien Devine and Red Lion Theatres New Red Lion Theatre Review by Simon Sladen (2011) Take 90 minutes, 37 plays, 3 actors, 1 famous bard, blitz them in a theatrical blender and what do you get? An evening of pure Shakespearean fun courtesy of The Complete Works of William Shakespeare (Abridged) .
    • 24. WHO DO WE SEE? Estimated number of patient contacts by discipline Financial years 2003/04 to 2009/10 0 5 10 15 20 25 30 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 Financial Year Contacts [million] Health Visitor District Nurse Practice Nurse General Practitioner
    • 25. WHAT DO WE SEE? <ul><li>Top 10 conditions - GP and practice nurse per 1,000 </li></ul>0 40 80 120 160 200 240 280 Circulatory and respiratory S&amp;S General abnormal S&amp;S NEC Hypertension Diseases of the skin &amp; subcutaneous tissue Digestive/abdominal S&amp;S Neurological/musculoskeletal S&amp;S Psychological S&amp;S Diabetes Soft tissue disorders Infectious diseases GP &amp; PN contact rate per 1,000 population GP PN
    • 26. WHAT HAPPENS TO THEM? <ul><li>“ view the NHS as a service delivered predominantly in local communities rather than in hospitals; 90% of health care is delivered in primary care but we still focus the bulk of our attention on the other 10% - our current emphasis on hospitals does not provide the care that people are likely to need.” </li></ul><ul><li>Professor David Kerr 2005 </li></ul>
    • 27. WHAT HAPPENS TO THEM? <ul><li>Around 1 in 50 GP consultations results in an emergency inpatient admission. Thus 1000 GP consultations will result in 20 emergency inpatient admissions. If all GPs were able to refer only one fewer person in 1000 consultations ( i.e. referring 19 rather than 20 individuals), it would produce a 5% reduction in GP referred emergency admissions. </li></ul><ul><li>Professor David Kerr 2005 </li></ul>
    • 28. LOTHIAN EXPERIENCE <ul><li>10% of practice population contact their practice every week </li></ul><ul><li>87% managed in Primary Care for next 4 weeks </li></ul><ul><li>13% - 48% OPD </li></ul><ul><li>6% A&amp;E </li></ul><ul><li>10% admissions </li></ul><ul><li>i.e. 2% result in unscheduled activity or 1.3% resulting in direct admission </li></ul>
    • 29. SO WHY BOTHER? 0 500 1,000 1,500 2,000 2,500 Global Sum QoF Premises Enhanced Services Board Administered Funds Unplanned Admissions Prescribing New Outpatient attendances Direct access A&amp;E £m Non Contracted=£3.7bn Contracted=£700m
    • 30. SO WHAT ARE WE DOING? <ul><li>The Quality Strategy &amp; DQPC </li></ul><ul><li>Closer working – look at variation and engage in a dialogue – 20% reduction in plain x-rays from one board 40% reduction in dermatology referrals form another </li></ul><ul><li>QPQOF </li></ul>
    • 31. QPQOF <ul><li>3 work-streams – referrals, admissions and prescribing </li></ul><ul><li>3 activities – internal review of data, external peer review of data, agree on actions for prescribing and care pathways for referrals and emergency admissions </li></ul>
    • 32. And so to the Future… <ul><li>Continue to develop QPQOF and emphasis on whole system working </li></ul><ul><li>“ Care delivered at the right time in the right place by the right person” </li></ul><ul><li>Align local and national enhanced services to support </li></ul><ul><li>Support AHP and Community Nursing to realign work priorities to support people to remain out of institutional care </li></ul>
    • 33. Improving Patient Safety in Primary Care - The story so far Neil Houston, NHS Forth Valley
    • 34. SUB HEADING
    • 35. SUB HEADING
    • 36. Safety Improvement in Primary Care (SIPC 1)
    • 37. Aims: To enable 80 Primary Care teams to: 1.Identify and reduce harm to patients 2. Improve reliability of care for patients On High Risk Medications With Heart Failure 3.Develop safety Culture 4.Involve Patients in QI
    • 38. Knowledge <ul><li>Topics </li></ul><ul><li>Tools </li></ul><ul><li>What to spread? </li></ul><ul><li>How to spread? </li></ul>
    • 39. 1. Reliable Care – Care Bundles 4 or 5 elements of care Evidence based Across Patients Journey Creates teamwork Done reliably All or nothing Small frequent samples
    • 40. Heart Failure Bundle <ul><ul><li>1.Maximise medical therapy – </li></ul></ul><ul><ul><li>On a licensed B Blocker </li></ul></ul><ul><ul><li>B Blocker at max tolerated dose </li></ul></ul><ul><ul><li>2.Functional assessment - NYHA recorded in last year </li></ul></ul><ul><ul><li>3.Immunisation - pneumococcal vaccine ever </li></ul></ul><ul><ul><li>4.Self Management- information given to patient on recognition of deterioration </li></ul></ul><ul><ul><li>Improve QOL </li></ul></ul><ul><ul><li>Reduce admissions </li></ul></ul>
    • 41. Bundles - Successes “ The care bundles were useful because it identified gaps” Revealing unreliable practice Indicating areas for improvement
    • 42. 2 – Data
    • 43. Seeing Improvement “ You can see week by week, month by month, whether or not you are showing any improvement, we seem to be improving and that’s good”
    • 44. Tayside
    • 45. Lothian
    • 46. Outcome Data
    • 47. Trigger Tools To identify and reduce harm
    • 48. SUB HEADING
    • 49. SUB HEADING
    • 50. &nbsp;
    • 51. Expectations Hard to do Time Consuming Would not find harm Threatening
    • 52. Experience <ul><li>Challenges </li></ul><ul><li>Logistics </li></ul><ul><li>Training support </li></ul><ul><li>Variation </li></ul><ul><li>?For measurement </li></ul>Positives Quick Finding Harm Cultural change Improvement
    • 53. “ Seemed a bit intimidating when we first had it presented to a large group … much easier to use in practice … it’s a remarkably effective tool for reflective analysis on patient safety and other clinical issues …has created a lot of interest from other doctors in the practice as a tool for professional development and for appraisals” Doctor Gordon Cameron GP Edinburgh
    • 54. Safety Culture
    • 55. Safety Climate Survey <ul><li>On line </li></ul><ul><li>Practice report </li></ul><ul><li>Measurement </li></ul><ul><li>Diagnosis </li></ul><ul><li>Catalyst for change </li></ul>
    • 56. Insights “ Many of us in the practice staff hadn’t really made the link that us failing to communicate in was a threat to patient safety ….we had a lot of really good stuff came out of it, a lot of very open discussion”
    • 57. Experience so Far Practices are interested Acts as a catalyst Need guidance and support Better process and report Challenges – understanding/using it /anonymity
    • 58. Developing a Programme <ul><li>Scoping </li></ul><ul><li>Develop aims/measures/tools </li></ul><ul><li>Implementation strategy </li></ul><ul><li>Launch 2013 </li></ul><ul><li>Looking for volunteers….. </li></ul>
    • 59. Productive General Practice Susan Bishop &amp; Mary Freel
    • 60. Aim <ul><li>Introduce the Lean context for Productive General Practice and describe PGP’s structure </li></ul><ul><li>Explain how it can support you in Delivering Quality in Primary Care </li></ul><ul><li>Describe how it’s being used and some examples of the benefits it offers </li></ul>
    • 61. Productive General Practice uses Lean Principles <ul><li>Specify what does &amp; does not add value – from the patient’s perspective. </li></ul><ul><li>Identify steps necessary to design, order and produce across the whole value stream . </li></ul><ul><li>Make those actions flow without interruption, detours, waiting or rework. </li></ul><ul><li>Only make what is pulled by the patient. </li></ul><ul><li>Strive for perfection by continually improving &amp; removing wastes as they are uncovered. </li></ul>
    • 62. Why is it relevant? <ul><li>Lean is a systematic approach to reducing waste through a process of continuous improvement </li></ul><ul><li>Waste is anything other than the minimum amount of Practice equipment, materials, space and time which are essential to add value to the patient or service. </li></ul><ul><li>A Lean ‘Goal’ is to supply a product or service to the patient’s demand with 100% quality </li></ul><ul><li>Making the right thing easier to do – for every person, every time </li></ul>
    • 63. The benefits it offers… Stanley Medical Group, County Durham <ul><li>Reviewed their recall system for patients needing routine drug monitoring </li></ul><ul><li>Applied lean principles to understand the current process and design an improved process </li></ul><ul><li>Existing system lead to inconsistencies, waste and patient safety risk </li></ul><ul><li>Results: </li></ul><ul><ul><li>Patient Safety (faster lead time and higher degree of accuracy) </li></ul></ul><ul><ul><li>Time (35 hours/month to 0.53 hours/week) </li></ul></ul><ul><ul><li>Patient experience (increased HCA patient facing time) </li></ul></ul><ul><ul><li>Money (£4150/year) Stanley Medical Group, County Durham </li></ul></ul>Source: Iain Smith, Corporate Improvement Team, North East Transformation System “ Streamlining this process has saved us time but the real benefit has been that we have improved patient safety and the patient experience, as we are now able to offer more appropriate appointments” Sue Elsbury, Practice Manager
    • 64. The benefits it offers.. William Brown Centre, Peterlee <ul><li>Practice nurse team applied 5S, a fundamental lean tool to their working environment </li></ul><ul><li>Impact </li></ul><ul><ul><li>Reduction in inventory </li></ul></ul><ul><ul><li>Reduction in interruptions to consultations </li></ul></ul><ul><ul><li>Improved efficiency (e.g. staff walking distances reduced from 174 steps/ patient cycle to 18 steps/ patient cycle </li></ul></ul>“ By using simple tools to make simple changes you can made a lot of difference and I would recommend it to anyone thinking of using this approach” Dr Russell, GP Source: Iain Smith, Corporate Improvement Team, North East Transformation System
    • 65. The background to PGP in Scotland <ul><li>Focus on improving both quality and efficiency </li></ul><ul><li>Delivering Quality in Primary Care Action Plan </li></ul><ul><li>Working partnership </li></ul><ul><ul><li>Scottish Government </li></ul></ul><ul><ul><li>Institute for Innovation and Improvement </li></ul></ul><ul><ul><li>RCGP Scotland </li></ul></ul><ul><ul><li>Quality Improvement Hub </li></ul></ul><ul><ul><li>Primary Care Leads </li></ul></ul>
    • 66. &nbsp;
    • 67. Productive General Practice in Scotland <ul><li>UK launch in November </li></ul><ul><li>Grampian, Tayside and Glasgow developing, or testing modules </li></ul><ul><li>Early Adopters in Grampian and Tayside starting August </li></ul><ul><li>www.evidenceintopractice.scot.nhs.uk </li></ul><ul><li>Expert advice and coaching Quality &amp; Efficiency Support Team &amp; RCGP </li></ul>
    • 68. The Crescent Medical Practice Patient survey response 96%
    • 69. The Crescent Medical Practice How do staff feel about practice?
    • 70. The Crescent Medical Practice How do staff feel about practice? 1.83 2.22 2.09 2.04 2.10 1.91 Whole Practice 0.4 0.5 0.7 0.6 0.4 0.3 Practice Management 2 2.83 2.5 2.33 2.83 2 Reception 3 3 4 3 4 4 Admin 1 3 1 1 1 1 Nurses 2.75 1.75 2.25 3.25 2.25 2.25 GPs Change And Innovation Work Life Balance Internal Comms Handling Conflict Team Working Decision Making Whole Practice Average
    • 71. NHS Lothian’s PC Forward Group Duncan Miller General Manager, Primary Care Contracts, NHS Lothian
    • 72. DELIVERING QUALITY IN PRIMARY CARE: THE JOURNEY SO FAR <ul><li>Closing thoughts...... </li></ul>
    • 73. Securing success…. <ul><li>Empowered patients – high quality preventive and reactive health care </li></ul><ul><li>Enabled professionals – innovative multi-professional teamwork – pulling together </li></ul><ul><li>Effective leadership – vision, courage and en courage ment </li></ul><ul><li>Excellence in practice – pressing on </li></ul>
    • 74. Success is a journey….. not a destination!
    • 75. Thank you for listening Thank you for coming and participating
    • 76. Reminder Invitation You will be most welcome to attend our Delivering Quality in Primary Care Fringe Session ...... 4:45-7pm today
    • 77. <ul><li>Questions/ thoughts/ comments…? </li></ul>

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