Report precentation


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รายงานการศึกษาดูงานปฐมภูมิ ประเทศอังกฤษ

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  • -แลกเปลี่ยนประสบการณ์-การควบคุมและป้องกัน taskforce-ส่วนตัวและศักดิ์ศรีเสมอภาคและความหลากหลายของกลุ่มสิทธิมนุษยชน
  • Report precentation

    1. 1. Townhill Medical Practice, Caterham, Surrey,
    2. 2. The United Kingdom• Population: 59 million• Capitol: London• Includes: England, Northern Ireland, Scotland and Wales• Government: Constitutional Monarchy
    3. 3. Yorkshire and The HumberLeeds Partnerships NHS FoundationTrust East MidlandsNHSSheffieldYorkshire Ambulance Service NHS University Hospitals of LeicesterTrust East Midlands Ambulance ServiceNHS Leeds NHS TrustBradford & Airedale Teaching PCT NHS Leicester CityNHS Doncaster Lincolnshire Teaching PCT NHS Nottingham City Leicestershire Partnership NHS TrustWest Midlands LondonHeart of England NHS Foundation Trust Kings College Hospital NHSWalsall Integrated Learning Disability Foundation TrustService NHS NewhamNHS Wolverhampton City East London Foundation TrustNHS South Birmingham Royal Free Hampstead NHS TrustNHS Birmingham East & North NHS Lewisham NHS EalingSouth West South East CoastNHS Bristol Surrey & Borders PartnershipSouth Western Ambulance Service NHS NHS TrustTrustNHS Cornwall and Isles of Scilly NHS Hastings & RotherNHS Gloucestershire East Kent Hospitals NHS TrustNHS PlymouthNHSSwindon NHS Eastern & Coastal Kent SEC Ambulance Service Trust
    4. 4. Health System Overview National Health Service Act 1948—based on Beverage Report and the belief in post-World War II solidarity. British NHS: National Health Service, first comprehensive, nationalized healthcare program. Highly centralize management and finance Patients choose their provider Providers can have public & private practices
    5. 5. Principle of the NHS  NHS Founding principles ‒ ‒ ‒ ‒ ‗Cradle to Grave‘
    6. 6. Secretary of State for Health • By: Dr Vannaboon Phag-Udom • Secretary of State for Health • MBBS DRCOG MRCGP Department of Health – • Department of HealthStrategic Health Authorities – NHS • Strategic Health AuthoritiesSpecial Health – Authorities – Primary Care Trust – – Primary Care Trust • Special Health Authorities NHS Trusts – Provides health services to the whole population and help with decision making e.g. NICE, NHS Direct • Primary Care Trust – Primary Care Team , • NHS Trusts – Provider bodies like Hospital Trust, Ambulance Trust, Mental Health Trusts, Foundation Trust • Primary Care Team – Provides Healthcare in Primary care setting
    7. 7. - NHS General Taxation • 95%National Insurance & Prescription co-payment DOH • National Insurance and Prescription co- SHA payment PCT • PCT 80% NHS
    8. 8. Structure of UK Health Services
    9. 9. Primary Care TrustsThe center of the NHS, control 80% of the total NHS budget• PCTs are responsible for: – Assessing the health needs of the local community. – Commissioning the right services, for instance from GP practices, hospitals and dentists. – Improving the overall health of their local communities. – Ensuring access to services – Monitor interaction of social and healthcare organizations. – Annual assessment of GP practices in their area. – Buy and monitor servicesThere are more than 300 PCTs covering all parts of England since April 2002, which report directly to their local Strategic Health Authority.
    10. 10. PCT -- • • • • – –
    11. 11. PCT contracts• With owner of the Surgery – ‗Partners‘• Agreement on services to be provided and their quality• Up to the partners to provide the services however they see fit• Increasing competition from Private sector
    12. 12. Payment to the contract holder• Global Sum • Estimate per head to provide services, including staff costs• Enhanced services • Extra work e.g. Travel immunisation and Minor surgery• Quality payments • Target based• Premises
    13. 13. Quality payments
    14. 14. Health Services Workforce More than 1 million employees, largest single employer in Europe • MD‘s: 2.1 per 1000 pop (low #) (OECD 2002) • General Practitioners (GPs): 60% • GPs handle 90% of episodic care; gatekeepers • GPs paid by mix of capitation, salary, fees • Specialists are hospital based, called ―Consultants.‖ • Specialists/Hospitalists are salaried • All MD‘s can have public and private practices
    15. 15. How much do GPs earn Depends on how much work & on what contract Typical Partner earns £90,000 to £110,000 per annum Salaried GP earns £75,000 to £85,000 per annum Locum GP earns £65 to £85 per hour More than NHS paid Hospital Consultants
    16. 16. Health Services Workforce • Nurses largest group within NHS staff • 40% of NHS budget • Nurses are trained specialist (child, MH) • Work closely with GPs in the community • Hospital nurses, much dissatisfaction salaries, working conditions, work load. • Nursing shortage • NHS is actively recruiting Indian, Spanish and Philippine nurses to make up for shortages in the field.
    17. 17. Nurses Training • 3 year Diploma or 3 year Degree • Seniority grading 1. Registered Nurses 2. Specialist practice qualification 3. Clinical Nurse Specialist 4. Nurse Practitioners 5. Nurse Consultant • Pay depending upon grade
    18. 18. Townhill Medical Practice•• 15,000• 5 partners (4/5 GPs are GP trainers)• 3 part-time GPs• 3 GP trainees(GP registrars:• 2 Nurse Practitioners• 2 Practice Nurses• 2 Healthcare assistants• 1 Practice Manager (+ 1 Assistant Practice Manager, 1 Finance A Group Practice
    19. 19. • District Nurses• Health Visitors• Community Midwifes• Palliative Care Nurses
    20. 20. • 8.00- 13.00, 14.00-18.00)• – GPs and NPs – Flexible Clinics ( practice nurses)• – Antenatal Clinics – Child Developmental Clinics – Child Immunization Clinics
    21. 21. Visit the Surgery
    22. 22. ?
    23. 23. Touch Screen for Self Registration•••
    24. 24. Electronic medical record (EMR)PaperlessConfidentiality
    25. 25. Provide primary care by teamsPhone-in &welcome to see patients10 minute consultationTelephone encounterEnhance patient responsibilityMinor operationHome visitQuality and infectious controlComprehensive and coordinate
    26. 26. British National Formulary & eResources
    27. 27. Prescription and payment•• Co-payment: per drug items ~ £7.4/item
    28. 28. What if patient needsmedication?  Prescription pads  Exemption  <16  <19 and in full-time education  >60  maternity  Chronic medical problems  pre-payment  War pension cert  contraceptives  Otherwise pay £7.40 per item  Then goes to any chemists to ‗cash-in‘ script
    29. 29. Prescription charges• As of April 2008 the prescription charge for medicines is set at £7.40 Northern Ireland £6.85, Scotland £5 and Wales free• GPs can prescribe a maximum three- month supply of the medication• Except from paying for: – People over sixty – Children under sixteen or under nineteen if the child is still in full time education – Patients with certain medical conditions
    30. 30. • Allergic condition – hay fever etc • Conjunctivitis • Coughs and colds • Diarrhea • Fungal infections – thrush, athlete’s foot etc • Hay fever • Indigestion • Muscular aches and painsOver-the-counter • Toothache and teething problem • Acne • Allergic rashes • Constipation • Cystitis • Emergency contraception • Hemorrhoids • Head lice • Mouth ulcers and cold sores • Sore throat • Warts • Worm
    31. 31. Electronic or LetterContinuing of data between sites
    32. 32. Quality and Outcome Framework (QOF)
    33. 33. In the Practice Nurse Makes differential diagnosis & clinical Practitioner management Flexible clinic INR clinic Travel clinic Practice Nurse Wound management Immunization Smear clinic AMB ECG’s BP’s Midwife ANC and PP
    34. 34. In the community District Nurse Visit people: providing clinical care for patientsCommunity staff nurses Health Promote good health and prevent Visitors illness in the communitySchool nurseSpecialist Palliative careNurse
    35. 35. NP
    36. 36. PN
    37. 37. Heath careAssistant
    38. 38. Vaccine Clinic
    39. 39. ANC
    40. 40. Well baby clinic
    41. 41. Baby café
    42. 42. My Surgery  Elm Grove Medical Centre  1 doctor  1 nurse  3 receptionists  1 deputy manager  1 practice manager  Serves 2,000 patients
    43. 43. Modern Health Centre  Amersham Health Centre  6 doctors  1 trainee (Registrar)  1 nurse practitioner  3 practice nurses  8 receptionists  1 practice manager  1 computer manager  1 records manager  3 secretaries  Serves 11,000 patients
    44. 44. Settings for care Community Based Hospital Based Specialist & Specialist Led Primary Care Lead Primary Care GP / Practice Nurse & Others
    45. 45. Diabetes Service Model Level One Level Two / Level Three Level Four Primary Care Community Diabetes Team Secondary Care GP Led GP & Specialist Led Consultant Led Multidisciplinary Routine Care Extended care in community settings Joint Specialist Clinics undertaken Dietetics T1D Patient Education with specialist support by Podiatry Programmes phone/email Patient Education Programmes Insulin initiation Multi-disciplinary clinics Insulin Pump Patients can Specialist clinics telephone/email access advice by phone/email advice Dieticians, Podiatrists, DSNs and Psychologist Inpatient assessment GPs and practice and management nurses training Insulin initiation Training Support Development
    46. 46. Settings for Care (3) Case review e-mail / telephone / virtual clinic Progression CKD support. Anaemia Specialist clinic – including dietetic Bone Disease support Joint Kidney / Diabetes Poor Control e.g. BP > 150 despite 3 Services if nephrotic / anti-hypertensives eGFR <30 Hyperkalaemia / Preparation for ESRF Advice on use oral hypoglycaemics Patient Education / Support Blood Pressure treatment / Management of Risk factors Use of RAS inhibitors Microalbuminuria / eGFR Screening More regular follow up enhanced screening eyes / feet FBC / Renal Bone Disease
    47. 47. Newly Diagnosed Diabetes / Diabetes Screening Diabetes suspected – initial assessment No diabetes but at Diabetes confirmed Lifestyle advice risk Adults with DKA or ketones in urine, Adults under 30 All other adults – HONK – URGENT blood glucose with signs/ initiate referral to hospital >25mmol/l symptoms of management specialist team URGENT referral Type 2 to within primary to specialist specialist-led care service for triage team for triage Inpatient - Optimisation of blood glucose insulin therapy control with oral therapies or Criteria lifestyle changes and initial training Optimisation of blood glucose control with insulin or oral therapies Primary Care / Community Community / Specialist Tailored education programmes Secondary Care setting Indicators of quality numbers emergency admissions / numbers (proportions) completing education Estimated prevalence / prevalence on Register / Qoff Numbers with retinopathy
    48. 48. Rapid Access Health Telephone Professional Advice EducationPractice based Community Diabetes Community Insulinjoint clinical Team startsconsultations / Diabetes Network Community Patient Nurse Education support Patient Participation
    49. 49. Who is Commissioning Telecare • Social Care Providers • Primary Care Trust • District and Borough Councils • Acute Hospital Trust • National Health Service • Department of Health • Supporting People • Registered Social Landlords • Private Health Providers
    50. 50. Surrey Telecare Projects• Hospital Discharge Project• Wrist Care• Passive Falls Monitoring• Dementia Monitoring, Extra Care and Residential Care Homes• Prescription Compliance & Dementia Monitoring• Monitored Smoke Detectors• COPD Project
    51. 51. The Patients‘ Council Derek CooperPatients‘ Council ChairmanMaking it Better for Patients
    52. 52. The Patients‘ Council2009 - 2010, Another Eventful Year Allyson Jenkins Patients‘ Council Vice-Chairman Making it Better for Patients
    53. 53. The Role of the Patients‘ Council To be the voice of patients and the public To be independent, supportive and challenging To be involved in Trust activities To contribute to the future direction of the Trust NOT to be directly involved in the management of the Trust
    54. 54. Patients‘ Council ActivitiesTrust Board MeetingsManagement Briefing MeetingsRepresentation on Trust Core GroupsRepresentation on Consultation GroupsRepresentation on User GroupsMeeting Patients and Visitors at Trust Events
    55. 55. Presentations to the CouncilCancer ServicesProtection of Vulnerable AdultsThe Productive WardImproving Patient CarePatient Reported Outcome MeasuresMaternity ServicesStroke Prevention and TreatmentReal Time Patient Monitoring
    56. 56. Patients‘ Council Core Groups Patient Experience Group Infection Prevention & Control Taskforce Privacy & Dignity Group Productive Wards Group Patient Environment Action Group Equality, Diversity & Human Rights Group Patient Information Group Travel Plan Group
    57. 57. Our Working Philosophy The Patients‘ Councilbeing a positive and constructive force within theHospital Trustrepresenting patients‘ views in shaping the futuredevelopment of the Trust and the Patient Experienceworking together for the benefit of patients, visitors andall those who use the services of the Trust Making it Better for Patients