PRIMIS

1. PRIMIS 23rd April 2002 Metropole Birmingham

2. Primary Care The changing future

3. What will change? • What we do • Who we work with • How we plan, develop and deliver services

4. What will change? • What we do • Who we work with • How we plan, develop and deliver services

5. Volume of Activity Distance The Concept of Migration National Supra Regional Regional Sub Regional DGH PCT Locality Practice Home

6. What will change? • What we do • Who we work with • How we plan, develop and deliver services

7. Partnerships

8. Balancing capacity and demand Referral and discharge protocols Secondary Care Primary Care Health promotion and disease prevention Maximising independence Social Services Throughput planning and admission prevention Discharges and delayed discharges Integrated service planning and delivery Planning for change Operational Strategic Intermediate care

9. What will change? • What we do • Who we work with • How we plan, develop and deliver services

10. KEY WORDS Access Priority Quality Equity Modernisation Supply Demand

11. Service demand and capacity Unmet need Met need Demand Capacity

12. Demand management? The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

13. Demand management? The process ofidentifying where, why and by whomdemand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

14. Demand management? The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

15. Demand management? The process of identifying where, why and by whom demand for health care is made and the best methods of curtailing, coping or creating this demand such that the most cost effective, appropriate and equitable health care system is developed.

16. GP booking schemes NICE referral guidelines Priority scoring systems Form referral letters Prevention Self-care PCT held waiting lists Waiting list validation Facilitated early discharge Intermediate care services Hospital at home schemes One stop rehab teams Direct booking at O/P appointments Nurse led pre-assessment clinics Clinics outside normal working hours Consultant out-reach clinics GP clinical assistants in O/P Community multidisciplinary teams - care at home Triage for primary care Triage for secondary care GP specialists Email consultation Telemediine Primary based alternatives to hospital delivery eg minor surgery Different use of GP time Alternatives to GP Systematic secondary prevention in primary care Survey high DNA rates Develop DNA policy “Follow up” reviews PATIENT GP O/P REFERRAL O/P CLINIC WAITING LIST PROCEDURE DISCHARGE

17. Adjusting referrals Unmet need Met need Demand Capacity

18. 110% Adjusting referrals 1:3 referrals may be avoidable 1:6 referrals may be avoidable with targeted GP education Unmet need Met need Demand Capacity

19. Adjusting referrals 1:3 referrals may be avoidable 1:6 referrals may be avoidable with targeted GP education Met need Demand Capacity

20. Protocol driven referrals Adjusting referrals 1:3 referrals may be avoidable 1:6 referrals may be avoidable with targeted GP education Met need Demand Capacity Met Filled

21. More than 10%imbalance Unmet need Met need Demand Capacity

22. Adjusting services Could be done in primary care Must have secondary care Demand Capacity

23. Adjusting services Could be done in primary care Must have secondary care Demand Capacity

24. Adjusting services Could be done in primary care Must have secondary care Demand Capacity

25. Adjusting services Could be done in primary care Must have secondary care Demand Capacity

26. Adjusting services Could be done in primary care Must have secondary care Unmet need Capacity filled

27. Adjusting services Could be done in primary care Must have secondary care Demand Capacity

28. Adjusting services Could be done in primary care Must have secondary care Demand Capacity

29. Adjusting services Could be done in primary care Must have secondary care Demand Capacity

30. Must have secondary care Protocol driven referrals Adjusting services Could be done in primary care Demand Capacity

34. Endoscopy services

35. Activity rates - City PCT • Nuffield access equates to high referrals • Average gastroscopy activity is 5.4 per 1000 population

36. Expectation of need • BSG Working Party Report 2001 Put these figures back to the upper GI diagnostic graph

37. Expected Average Activity rates - City PCT • Nuffield access equates to high referrals • Average gastroscopy activity is 5.4 per 1000 population Expected increase

38. Expectation of need • BSG Working Party Report 2001 More procedures needed for City: Upper GI diag 1646 Flex Sig 368 Colonoscopy 473 Total 2487 or 50 procedures per week 60 extra NHS procedures per week if include Nuffield activity 27 MORE colonoscopies per week predicted by BSG

39. Primary care managing throughput • Delayed discharges (5/95) • Managing care • Managing waiting lists • Clinically • Comparatively

40. Secondary Care Referred patients Primary Care Discharge • Protracted affair • Push system • Delay inevitable • Poor management of referred patients during wait • Poor management of waiting lists • Little co-ordination between various agencies

41. Admission avoidance Secondary Care INTERVENTION Pre-intervention and reablement function Reduced independence Reabling independence Primary Care Best independence

42. Balance • Between demand and capacity • Between availability and need • Between needs and wants

43. PRIMIS 23rd April 2002 Metropole Birmingham