Bridging the gap between specialist and primary care - Mike Morgan in conversation with Stephen Gaduzo
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The UK lags behind other countries in both the timeliness of diagnosis and access to specialist care. One important factor is the nature of our health service where primary care is the gatekeeper to specialist care. At present primary care is under great pressure with growing workload and increasing expectations. Meanwhile respiratory specialists are largely confined within hospitals and not able to operate in the community freely where their skills may be better employed. This separation is further exaggerated by the disparate and independent nature of the organisations that employ specialists and general practitioners. If the NHS in England is to work well in future then there has to be a change in the way that care is provided. Some of these are set out in the Five Year Forward View and describe different models of vertical integration. In this webinar Mike Morgan and Stephen Gaduzo intend to explore the different ways that GPs and specialists can work together to improve diagnosis and management of common respiratory conditions beyond the traditional hospital referral.
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Bridging the gap between specialist and primary care - Mike Morgan in conversation with Stephen Gaduzo
- 1. www.england.nhs.uk 27/03/ 2015 Bridging the gap Respiratory Futures Webinar Debate No.3 27th March 2015
- 2. www.england.nhs.uk Bridging the gap “a conversation” GP Specialist
- 3. www.england.nhs.uk Topics of “conversation” • Communication • Models of specialist provision • Standardisation of patient information, self-management tools etc. • Care bundles across the sectors • Early diagnosis tools • Spirometry provision • Resources to promote closer working 27/03/2015
- 4. www.england.nhs.uk General Practitioner Specialist Patient Public funding and public provision Public funding Increasing marketisation
- 5. www.england.nhs.uk Barriers to access Primary care Acute Trusts GP Specialist Care Structural barriers? Commercial barriers? Professional?
- 6. Communication • “Why don’t hospital OPD letters include hospital spirometry readings as a matter of course?” • “And why will the secretary not send the information to me when I request it?” • “Why don’t GPs send vital information in their referral letter?” • Why don’t we have shared records?
- 7. Communication • GP access to hospital letters on line • GP access to on line X-ray results and films • Hospital access to GP records • GP clinical records systems electronic for decades • How many hospitals also electronic? • What do community teams use? • What about social services, district nurses, etc?
- 8. SMPs • Which asthma or COPD self-management action plan do you use? Why? • Do GPs, PNs, community teams and hospital teams use the same plan? If not why not? • Do they tie in with antibiotic guidelines? • Same recommendation for length and dose of prednisolone therapy?
- 9. www.england.nhs.uk New Models of Care • MCPs • PACS
- 10. www.england.nhs.uk New models of care • Greater devolution • More co-commissioning • Maximising local planning • Encouragement of new models of care • Revitalising small hospitals • Getting serious about prevention • Empowering patients (PHBs etc.) • Focus on success not failure • Parity for mental health • Greater efficiency 27/03/2015
- 11. www.england.nhs.uk What will happen to general practice? • More investment • Move away from individual small practices • Federations • Multi specialty community providers 27/03/2015
- 12. www.england.nhs.uk What will happen to acute trusts? • Get smaller • Less investment • Less emphasis on urgent care • Focus on elective and specialised care • Closer working with primary care • Gradual vertical integration (Primary and Acute Care Systems )
- 13. Inreach, outreach? • Understanding needs • Respect • Education • Regular meetings • Leadership • Integration on various levels • GP attends OPD and “audits” Mx and review • Specialist allotted time in 1y care for specific purpose (MM) • Tier 2 / GPSI • Truly integrated posts and services (e.g. Sanford)
- 14. Effecting Quality in Practice Equip and Improvement tools
- 16. What worksheets are available? • Reviewing asthma diagnosis in children • Stepping down triple therapy in COPD • Reviewing high-dose ICS in asthma • Identifying undiagnosed COPD • Assessing patients with advanced COPD • Management of advanced COPD • Identifying high-impact COPD • Post-acute COPD care bundle • Accurate diagnosis of COPD • Post-acute asthma care bundle
- 17. BLF: 10 steps to best COPD care • Diagnosis confirmed with lung function test (spirometry) • I understand my COPD and my HCP has explained where to find info, advice and support • I’m supported to manage my care & have agreed SMP • Annual flu jab and 1 off pneumo jab • Regular support & treatment to help me stop smoking • Lifestyle, exercise, diet, pulmonary rehab • I know what my meds are for and when to take them • Inhaler technique • Exacerbations – guided self management • Regular, structured review http://passport.blf.org.uk
- 18. High impact COPD patients
- 19. Walk the 7 steps to the best asthma care • Diagnosis • Triggers and control • Encouraged, supported and actively involved in management • Medicines and inhalers • Written personalised action plan • Review • Healthy lifestyles NW SHA Resp Team 2013
- 20. Good technique doesn’t just happen
- 21. Greater Manchester Inhaler Technique Project http://wires.wessexahsn.org.uk/video-series/inhaler-technique
Editor's Notes
- Real questions from just this week, angry email from practice nurse who doesn’t want to duplicate efforts for herself and patients, then often asked question from hosp consultants receiving substandard referral letters!
- Integrated or collaborative care is going to require better records systems and sharing
- We use AUK asthma plans and our own COPD plans – the key is we ALL use same ones, whether hospital, community or 1y care – gives consistent message to patients and opportunity to communicate changes quickly
- The basics are the same
- Resources for PCRS-UK members
- Algorithm based, Flow chart stratifies population, suggests action for that group leading to improved care EG: COPD pts with MRC 3 or above ?referred for PR
- Now over 4000 hits on BLF website, results being analysed. I was brave enough to ask all my patients, are you?
- Produced by NW SHA lead team in 2013 but not taken further, worth pursuing?
- Links to videos and Leicester 7 steps cards. Inhaler technique vital but must be learned and taught correctly. Consistency of message
- A brilliant resource, we need to ensure hosting on Futures website as well as wessex ahsn and encourage everyone to use – patients and HCPs alike
- Pullout centre-fold of PCRU latest issue – practical summary of COPD management