Primary Care in the United Kingdom

Transcription

1 Primary Care in the United Kingdom Dr Mike Burrows Chief Executive Salford Teaching Primary Care Trust adding life to years and years to life IN Salford 1

2 Primary Care Background United Kingdom four separate healthcare systems England 152 Primary Care Trusts A financial allocation direct from central government PCTs Commissioning of services Provision of services Public Health role 2

3 Where is Salford? 3

4 Salford 230,000 population A post industrial city 35% of ward areas are in the 10% most deprived in the country PCT co-terminous with local government 4

5 Salford Male Life Expectancy Years / Salford England 5

6 Salford Female Life Expectancy Years / Salford England 6

7 Heart Disease & stroke in under 65s 151 Stroke 137 Cancers Colon 126 Lung 180 Oesophagus 153 Stomach 132 Anti-depressants 1/3 above national average Salford A Few Health Statistics Standardised Mortality Ratios (SMRs) 7

8 53 GP Practices 155 doctors Practices Primary Care in Salford Separate organisations Partnerships or sole traders Contractual relationship with the PCT as commissioner 8

9 Features of the GMS Contract Core contract based on population size Performance based component 3 domains Clinical Organisational Patient experience Specific funding for additional services National Local 9

10 Quality & Outcomes Framework (QOF) Clinical Indicators Secondary prevention of coronary heart disease Cardiovascular disease primary prevention Heart failure Stroke and Transient Ischaemic Attack Hypertension Diabetes mellitus Chronic obstructive pulmonary disease Epilepsy Hypothyroid Cancer Palliative care Mental health Asthma Dementia Depression Chronic kidney disease Atrial fibrillation Obesity Learning disabilities Smoking 10

11 Quality & Outcomes Framework (QOF) clinical domain examples Percentage of patients with coronary heart disease in whom the last blood pressure reading is 150/90 or less Percentage of patients with coronary heart disease whose last measured total cholesterol is 5mm/l or less Percentage of patients with hypertension in whom the last blood pressure reading is 150/90 or less Percentage of patients with diabetes in whom the last blood pressure reading is 145/85 or less Percentage of patients with diabetes in whom the last HbA1c is 7.5 or less 11

12 Quality & Outcomes Framework (QOF) Organisational Domain Records and information Information for patients Education and training Practice management Medicines management 12

13 Quality & Outcomes Framework (QOF) Patient Experience Domain Length of Consultation Access to a Primary Care Professional within 24 hours Access to a GP within 48 hours 13

14 Analysis of GP Practice Size in Salford Number of Patients Frequency

15 Number of GPs within Each Practice Frequency GPs 15

16 List Size (Number of Patients Per GP) Patient Numbers Frequency

17 List Size (Number of Patients Per GP) Patient Numbers > 1 GP Single GP Frequency

18 QoF Points Performance of Salford GPs Domain Maximum Available Points 2008/09 Points Achieved 2008/09 % Points Achieved 2008/09 Clinical 36,400 32, % Organisational 9,380 7, % Additional services 2,016 1, % Patient experience 8, % Total 56,000 46, % 18

19 Ghosh Pr Saxby K 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Coronary Heart Disease /09 % of patients with Coronary Heart Disease whose last measured total cholesterol (measured in the previous 15 months) is 5 mmol/l or less. 19 Davis Ws Borg-Costanzi Jm Larah Dg Sinha Rp Levenson S Rolfe Jn Tauk T Drs Nagesh & Chilamkurthi Sultan M Salim A Rahman A Element P Boyce Ct Finegan Na Salford Care Centres Weaste Buch Kh Singh Hs Warburton Salford Health Matters Ahuja A Browne Nb Mccorkindale S Collier Jeet I Lindsay Sd Yates Ms Tamkin Ej Sharma Mm Malcomson Ci Kassam Nn Singh H Haber S Khan Mt Dr Amin Kyaw T Hope B Dr Loomba Joshi V Marginson Je Dr Budden Randall Sc Tankel Jw Stedman Hgb Koria K Tyrrell Nm Allweis B Practice Name 10.00% 9.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% Gore H Leach G Locum To Dr Chowdhury(Jeet II) Achievement Prevalence % Exceptions % Not Achieved % Achieved % Actual prevalence Average Achievement

20 Kyaw T Khan Mt Tyrrell Nm Ahuja A Allweis B Lindsay Sd Dr Budden Yates Ms 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Diabetes Mellitus /09 % of patients with Diabetes in whom the last blood pressure was 145/85 or less 20 Mccorkindale S Hope B Saxby K Levenson S Boyce Ct Dr Amin Collier Locum To Dr Chowdhury(Jeet II) Tankel Jw Tamkin Ej Salford Health Matters Joshi V Rolfe Jn Singh Hs Malcomson Ci Marginson Je Randall Sc Element P Browne Nb Rahman A Warburton Ghosh Pr Koria K Stedman Hgb Finegan Na Sharma Mm Kassam Nn Sinha Rp Singh H Buch Kh Practice Name 10.00% 9.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% Salim A Gore H Sultan M Drs Nagesh & Chilamkurthi Leach G Borg-Costanzi Jm Tauk T Davis Ws Larah Dg Dr Loomba Salford Care Centres Weaste Jeet I Haber S Achievement Prevalence % Exceptions % Not Achieved % Achieved % Actual prevalence Average Achievement

21 Ghosh Pr Kyaw T Singh H Salford PCT - Practice Points Achievement 2008/09 21 Locum To Dr Chowdhury Lindsay Sd Ahuja A Rahman A Tyrrell Nm Mccorkindale S Drs Nagesh & Chilamkurthi PATIENT EXPERIENCE PATIENT EXPERIENCE ADDITIONAL SERVICES ADDITIONAL SERVICES ORGANISATIONAL CLINICAL Dr Amin Browne Nb Davis Ws Sultan M Rolfe Jn Buch Kh Salim A Finegan Na Borg-Costanzi Jm Boyce Ct Gore H Collier Randall Sc Joshi V Salford Health Matters Tauk T Element P Jeet I Marginson Je Allweis B Hope B Larah Dg Warburton Yates Ms Koria K Malcomson Ci Tamkin Ej Salford Care Centres Weaste Stedman Hgb Haber S Singh Hs Budden Sharma Mm Kassam Nn Dr Loomba Saxby K Khan Mt Tankel Jw All single GP practices Practice Name Leach G Levenson S Sinha Rp Total Points

22 Enhanced Services Anti-Coagulation Services Drugs Active Case Management Near Patient Testing Access/Extended Hours Heart Failure Services Homeless Services Minor Surgery Osteoporosis Cardio-Vascular Disease Smoking intrauterine contraceptive device (IUCD) Insertion IM&T Learning Disabilities HPV Vaccination Childhood Vaccination & Immunisations Safe Haven Service Influenza & Pneumococcal Immunisations Alcohol Tier 1 (DES) Alcohol Tier 2 (LES) Gateway Programme Ethnicity Health Inequalities Practice Based Commissioning Choice & Booking 22

23 Other Contractual Arrangements Personal Medical Services Contracts (PMS) Locally negotiated Based on GMS Contract Equitable Access Tendered Contract, open to competition 3 5 year contracts 23

24 The GMS Contract Key Points To Reflect On Based on need Clinical good practice incentives Flexibility in the way it can be delivered Encourages larger group practices Local tailoring via LESs 24

25 The GMS Contract Key Points To Reflect On Contract in perpetuity Clinical quality must be a process of continuous improvement Negotiated with a powerful body Doctors as practice mgrs with salarieds The single hander problem Limited use of flexibilities 25

26 Suggested Areas of Improvement Targets should be more and more challenging Percentage of income within QoF should increase Patient choice should be encouraged Good practice / innovation in contract use should be encouraged 26