The document outlines a presentation given at the 2nd National Primary Care Conference on better outcomes with scarce resources through primary care. It discusses the case for primary care and delivery solutions using total quality management approaches including mechanisms, methods and case studies from the UK of increasing practice capacity and delivering cardiovascular risk assessments through general practices. Examples are provided of monitoring and improving various clinical areas and outcomes.

1. 2nd National primary Care Conference
MPHC
14 November 2012
Primary Care Centre Stage – Better Outcomes
with Scarce Resources
Jack Nagle,
CEO, APC

2. Outline
• Case for Primary Care
• Delivery Solutions
– Mechanism
– Methods
– Example

3. Alpha Background
• Founded 2003 – Ireland & UK
• Models for Practice Management & Primary Care Centre
Development
• Gold Standard systems & methodologies for General
practice
• TQM – total quality management
• Worked in more that 100 + practices
• Developed primary care centres,
• Strategic partner of the NHS Alliance
• Compliance to Care Quality Commission regulations
© Alpha Healthcare Ltd, Confidential

4. Change is happening..
© Alpha Healthcare Ltd, Confidential

5. IMAGINE !
Imagine if every patient, who really needed a bed in
hospital had a bed available,
Imagine if many more people could be effectively treated
for chronic disease in their local communities,
Imagine if these two events were connected and
Cost LESS
For BETTER health outcomes
Imagine….
PRIMARY CARE
See case studies and info at www.primarycare.ie

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. 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,
• Key Enabler for :
– Efficiency improvements

8. SERVICE DELIVERY
Approach ( UK):
Commissioning :
- Process by which the health needs of the local population are identified,
priorities for investment are set and appropriate services are purchased and
evaluated
- National and Local incentives to promote
Provider:
- A health care provider is a legal entity, or a sub-set of a legal entity, which
may provide healthcare under NHS Service Agreements
- GP practice, NHS trust, Independent provider  provider organisations
Competition:
- Efficiency & value for money ?
- Regulation – Standards & Quality
I

9. Care Quality Commission – UK
HIQA Standards for Primary Care ?
CQC's Essential Quality & Safety Standards
Practices must meet these standards:
•OUTCOME 1: Regulation 15: Respecting & Involving people who use the services
Involvement & Information •OUTCOME 2: Consent to care & treatment
Personalised Care Treatment •OUTCOME 4: Care & welfare of people use use the services
•OUTCOME 5: Meeting nutritional needs
& Support •OUTCOME 6: Co operating with other providers
•OUTCOME 7: Safeguarding people who use services from abuse
•OUTCOME 8: Cleanliness & Infection Control
Safeguarding & Safety •OUTCOME 9: Management of medicines
•OUTCOME 10: Safety & Suitability of premises
•OUTCOME 11: Safety, availability and suitability of equipment
Suitability of staffing & •OUTCOME 12: Requirements relating to workers
•OUTCOME 13: Staffing
Suitability of Management •OUTCOME 14: Supporting workers
•OUTCOME 16: Assessing & monitoring the quality of service provision
Quality & Management •OUTCOME 17: Complaints
•OUTCOME 21: Records

10. Case Study :
TQM to Increase Practice Capacity
• Initial Consultation Rate = 8.17;
• After changes = 6.41
• 22% Improvement!

11. Case Study - NHS HEALTHCHECKS
Aim:
• Deliver cardio-vascular risk assessment to the eligible population within 5
years
• Assess 20% pa,
• Within general practice – reduce variability in levels of delivery,
Approach:
• Local Enhanced Service to encourage practice involvement,
• Improved patient care,
• Invite patients & do detailed health check risk assessment
• Communicate risk to patients & treat,
• Management in line with National Best Practice & NICE Guidance
• Payment to practices based on outcomes
ISO 9001 2008

12. Case Study - NHS HEALTHCHECKS
Goals for NHS Health checks at Medical Practice
• Suggestions from feedback session:
• Phase 1 3 sessions/wk -> 6 sessions w/k
75 a month -> 150 month
• Phase 2 6 sessions/wk -> 12 sessions wk
150 a month -> 300 month
• Value of Smoking Cessation -> NHS Health check
• Some patients for better Health Check
• Use some time from Better Health Clinics to NHS Health check
• Other “opportunistic” time to do NHS Health check
• Temporary capacity available from Diabetic Clinic
• Dressings – takes dedicated nurse time
• Travel Vaccination Time – seasonal (some time availability)
• Possibility of HCA doing NHS Health checks
ISO 9001 2008

13. Case Study - NHS HEALTHCHECKS
Macro Overview of Current Nursing Activity
Admin Practice Nurse
2 session/ week Clinics 10 /week
Healthcare
Assistant
16/week Baby
Nurse Practce Immunisations
4/week 1.5/week
Coils & Minor
Well Women
Surgery 5/week
2 session /week
Diabetic
3/week
Smoking
15/wk
NHS Healthcheck
3/week
Travel Clinic
1/week
Practice Nurse
Better Health Messages
12/week 1/2 session/ week
ISO 9001 2008

14. Case Study - NHS HEALTHCHECKS
160
NHS HEALTHCHECKS - MONTHLY LEVELS
140
N
120
o
P 100
e
r Total
80
Male
M
Female
o 60
n
t
40
h
20
0
Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12
ISO 9001 2008

15. Recap
• Significant change happening within healthcare,
• Primary Care – opportunities
• “More from less” through TQM!
Q&A