Jack Nagle looks at Supporting Quality & Efficient Delivery of Healthcare Services to Patients in Ireland and the UK.

1. Supporting Quality & Efficient Delivery of
Healthcare Services to Patients
Jack Nagle
CEO,
Alpha Healthcare

2. Outline
• Irish Healthcare System,
• Quality
• Benchmarking,
• Efficiency Improvements,
• The key role of IT
• Patient Care

3. Irish Healthcare System
• Undergoing major change on road to a Universal Health Insurance model
(to be introduced by 2016),
• HSE board resigned & replaced with interim – HSE & DOH officials
Seven pillars of care to be set up under individual directorships:
– Hospital Care,
– Primary Care,
– Mental Health,
– Children and Family Services,
– Social Care, Public Health and
– Corporate/Shared Services.
• Seven key Directors, one of the seven will be appointed as the Director
General.

4. Primary Care
• Appointment of Ministerial position for Primary Care,
• Dedicated budget,
• The Minister has established a project team to work on primary care
initiatives,
• Questions remain over the approach and pace of primary care development
in Ireland:
– Promoted as pillar of future healthcare delivery system,
– Slow pace of delivery in primary care centres,
– Slow pace in delivery of services,
– Roll out of CDM?
– PCT’s?
• Primary Care Teams mapping – 530 ( Target for end 2012 -485)
• Sought funding for the development of primary care centres,

5. Primary Care Team Structure
Network Services
Source : HSE f

6. 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 Zealand
Confidential

7. …

8. NHS Health System …
Vision - Key priorities for the “new” NHS are
– A patient led NHS,
– Better health outcomes,
– More autonomy and accountability
– improved efficiency
• NHS White Paper – “Equity & Excellence : Liberating the NHS”,
• CCG’s – GPs in the driving seat re commissioning of services,
• QIPP – Quality, Innovation, Productivity & Prevention - need
£20bn in savings by 2014/2015

10. Patient Choice -
• Choice of “any willing provider”
• Choice of consultant-led team
• Extended maternity choice
• Choice of mental health service
• Choice of treatment, care in long term conditions and end-of-life care
• Choice of any GP practice – not limited by where a patient lives or practice
boundary

11. 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,

12. HIQA

13. HIQA - Standards

14. CQC Registration & Compliance
• CQC – independent regulator of all health and social care
services in England,
• GPs & Primary Medical Service – register by April 2013
• Focus on outcomes;
• Looking at evidence;
• Practices will self declare;
• If not compliant in an area – show plan and timescale to
become compliant;
• Premises - if problems show how practice will overcome,

15. CQC – 16 Essential Standards
CQC's Essential Quality & Safety Standards
Practices must meet these standards:
•OUTCOME1: Regulation15: Respecting& Involvingpeople whouse the services
•OUTCOME2: Consentto care & treatment
Involvement & Information
•OUTCOME4: Care & welfare of people use use the services
•OUTCOME5: Meetingnutritional needs
•OUTCOME6: Cooperating with otherproviders
Personalised Care Treatment
& Support
•OUTCOME7: Safeguardingpeople whouse servicesfrom abuse
•OUTCOME 8: Cleanliness& InfectionControl
•OUTCOME9: Managementofmedicines
•OUTCOME10: Safety& Suitabilityof premises
•OUTCOME11: Safety,availabilityand suitabilityof equipment
Safeguarding & Safety
•OUTCOME12: Requirementsrelatingto workers
•OUTCOME13: Staffing
•OUTCOME14: Supportingworkers
Suitability of staffing &
Suitability of Management
•OUTCOME16: Assessing& monitoringthe qualityof service provision
•OUTCOME17: Complaints
•OUTCOME21: RecordsQuality & Management

16. 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,
• TQM tools to enable practice improvements by improving
quality of service delivery & efficiencies.

17. Case Study :
Reducing A&E and Emergency Admissions
Objectives:
– GatNet ( serving population ~ 250,000 patients NE
England),
– Improve continuity of care focused on best quality & best
value health care,
– Reduce increase in A&E activity
Challenges:
– Patient Access
– More efficient use of primary care resources

18. I
Case Study :
Reducing A&E and Emergency Admissions
Approach:
Commissioning Level:
- GatNet data gathering,
- GatNet guidance on “LIS” – local incentive scheme,
- Guidance generated for practices/health centres,
Provider Level:
- Review of practice /centre patient admission rates
- Identified avoidable admission episodes
- Identified patient access issues
- Practices signed up to incentivised LIS

19. Case Study :
Reducing A&E and Emergency Admissions
Approach ( Medical Centre, NE England – 15 GP Centre):
Access:
• Patient survey – find what patients want & problems with access
– Continuity of care important,
– Difficult to see preferred GP,
– Patients double booking,
– Complex system to see same day /urgent appointments
• Completed comprehensive clinical capacity analysis
– Re-defined appointments system
– Better matching of “urgent” to routine appointment slots to needs – timing!
– More streamlined for patients,
– Eliminated need for patient call backs,
– Introduced “dynamic” appointment system that responds to peak (urgent) day need

20. Case Study :
Reducing A&E and Emergency Admissions
Approach ( Medical Centre, NE England – 15 GP Centre):
Patients in Care Homes:
• Identified as one of the main areas for avoidable admissions,
• Optimise CDM of these patients
• Increase medication review rates to optimise treatment control
• Medication Review Protocol revised:
Diabetic Patient Care:
• Complex patient pathway for diabetic care;
• Access problems for patients,
• Backlogs of waiting patients

21. f
Case Study - Diabetes
Pathway:
• Identified access issues
• Reviewed patient pathway
• Set out review criteria
Podiatrist
Nurse
Dietician
GP
Patient

22. ISO 9001 2008
Case Study - Diabetes
Result:
• New patient pathway defined
• Improved Diabetic Clinical review
• Increased Diabetic review capacity by 100% in 3 months,
• Eliminated patient backlog
Leading to:
• Improved patient care,
• Clinically improved patient pathway
• Patients seen in community environment
• Better access

23. Benchmarking
• Key part of measuring a practice performance
• Positions practice,
• Focus for service delivery improvement,
• Improvement in practice efficiency,

24. Role of IT
• Good practice management software is critical to the efficient
and successful running of a practice,
• Essential records system for GPs & healthcare professionals,
• Carries the essential patient record and practice key
information,
• Database & records management system,
• Socrates very good package, easy to use, reliable and has a
suite of tools /reporting available,
• Good quality data is essential,

25. Clinical Audits
• Part of professional competence assurance
• Use of IT systems
– GP Practice Software
• CDM
– Patient data analysis
– EOL Care management
• Medication Reviews

26. Quality Outcomes Framework
• The Quality and Outcomes Framework (QOF) is a voluntary annual reward and
incentive programme for all GP surgeries in England, detailing practice
achievement results.
• Clinical Domain, Organisational Domain, Patient Experience Domain and
Additional Services Domain.
– clinical care: the domain consists of 86 indicators across 20 clinical areas (e.g.
coronary heart disease, heart failure, hypertension) .
– organisational: the domain consists of 36 indicators across five organisational
areas – records and information; information for patients; education and
training; practice management and medicines management.
– patient experience: the domain consists of three indicators that relate to length
of consultations and to patient experience of access to GPs.
– additional services: the domain consists of nine indicators across four service
areas – cervical screening, child health surveillance, maternity service and
contraceptive services.
• Aim of QOF is to improve standards of care by assessing and benchmarking the
quality of care patients receive.

27. Recap
• The importance of Quality - Total Quality Management,
• Benchmarking & Efficiency Improvements,
• IT & Practice Management Software critical
• Patient Care & Improved Service Delivery

28. THANK YOU
Q&A
For more info:
www.alphaprimarycare.com
www.alphaprimarycare.co.uk
www.primarycare.ie