Our business is improving the quality of primary care and creating opportunity for primary care to develop its services.

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Katherine Baker
5 years ago
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1 BICS Our Business Our business is improving the quality of primary care and creating opportunity for primary care to develop its services. Quality of experience care designed around individuals and subpopulations. Effectiveness helping patients to receive the right care at the right time in the right place. Value for money - putting primary care clinicians at the heart of decision making about how resources for patient care are used.

2 BICS Overview & Purpose BICS Gateway Management Service Redesign Clinical Service Provision Using demand data to drive condition specific, demand led services

3 What are we - nuts and bolts Company limited by shares, created in December shareholders among 47 of 48 GP practices GPs, Practice Nurses and Practice Managers Each shareholder holds one share, costing 1 Shares are non transferable Arts & Mems specify a not for profit organisation all surpluses reinvested in NHS Share holding entitles holder to vote in AGMs and EGMs Supports and develops a pool of 30 GP referral experts Holds an SPMS contract with NHS Brighton & Hove Employed staff and GP triagers entitled to NHS superannuation

4 Gateway to new ways of delivery Primary Care Return to practice Data Service Redesign Gateway Secondary Care Community Services New clinical services

5 Gateway Management BICS Gateway Management Service Redesign Clinical Service Provision Receives and records all elective care referrals from primary care Pathway from Choice to booking Clinical Triage by GP Peers

6 Service Redesign BICS Gateway Management Service Redesign Clinical Service Provision Data collection and Analysis Condition / Problem Specific Pathway Development Stakeholder Involvement Public and Patient Involvement

7 Clinical Service Provision BICS Gateway Management Service Redesign Clinical Service Provision Develops Provider Market by enabling a local collaborative / federal approach Provider of Infrastructure Support Contracting Direct clinical services provision

8 BICS Overview & Purpose (continued) BICS Gateway Management Service Redesign Clinical Service Provision Receives and records all referrals from primary care Data collection and Analysis Develops Provider Market Pathway from Choice to Booking Pathway Development Provider of Infrastructure support Clinical Triage by GP Peers Stakeholder Involvement Direct clinical services Provision Public and Patient Involvement

9 Demand management Demand Understanding Shaping Capacity Service redesign

10 Service redesign All Specialties 02/09/2008 to 02/02/ Allergy Audiology Breast Care Cardiology Cardiothoracic Surgery Care of Elderly Continence Adviser Dermatology Dietetics Endocrinology ENT ENT Gastroenterology General Medicine General Surgery Genito-Urinary Medicine Gynaecology Haematology Hepatology Infectious Diseases Maxillofacial Dentistry Nephrology / Renal Neurology Neurosurgery Ophthalmology Orthopaedics Musculoskeletal Paediatric Dentistry Paediatric Neurology Paediatric Surgery Paediatrics Pain Management Physiotherapy Plastic Surgery Podiatry / Chiropody Rehabilitation Rheumatology Speech and Language Therapy Thoracic Medicine Urology Vascular (blank)

11 Gynaecology Referrals - 1 September to 1 December 2008 (BICS data) Assisted Conception Cancer queries Cervical condition Coils Colposcopy Cystocoele Dyspareunia Early pregnancy queries Endocrine Fertility Fibroids Incontinence Menstrual problems Known Endometriosis Menopausal problems / HRT Not Specified Ovarian cyst / problem Pelvic Pain Postcoital bleeding Post-menopausal bleeding Prolapse Retrocoele Sterilization Vaginal discharge Vaginal soreness Termination of pregnancy Vulval

12 Gynaecology Menstrual Problems Audit (BICS data 1 September to 1 December 2008) Heavy regular periods no IMB or PCB - under 45 Heavy regular periods no IMB or PCB - over 45 Intermenstrual / PCB without pelvic pain - under 40 Intermenstrual / PCB without pelvic pain - over 40 Significant pelvic pain / dyspareunia > 10 week uterus Post-menopausal bleeding - 2 week rule Post-menopausal bleeding - not a 2 week rule Other (see notes)

13 Gynaecology Menstrual Problems Audit (BICS data 1 September to 1 December 2008) Experienced Nurse could manage Experienced Nurse could manage - to do Pipelle Experienced GP could manage / do Pipelle Consultant

14 Service redesign condition by condition Demand data GP referral threshold Clinicians GPs Consultants Nurses AHP s Task Group Who - competencies required Where - facilities required Project team What - outcomes expected

15 Referral? A B

16 Dyspepsia Referral? A B

17 BICS_logo.jpg BICS referral management Guidelines for Dyspepsia Patient presenting with Dyspepsia Alarm Symptoms any one or more of: - Weight Loss - Persistent Vomiting - Anaemia - Palpable mass in abdomen - Dysphagia - Age > 55 & onset < 1 year with persistent / continuous symptoms * * not included in NICE guidance Return to Practice for 2WW Refer Yes Treat full dose PPI for one month No Response to PPI Inadequate Adequate Trial of increased dose of, or different PPI either or HP serology Return referral to practices Inadequate Negative Positive Consider maintenance or prn PPI Yes Relevant to psychosocial factors No Rx eradication therapy Response? Manage as appropriate Consider referral to Gastroentorology No further Rx indicated Yes No Consider alternative diagnosis / other causes

18 Understanding variability in referral practice

19 - Referrals per session, all doctors ranking - (April - June 2010) M M

20 Referrals per Session 2008/9 referrals per session (annual) 2010 Q2 referrals per session (Quarterly) Dr 1 Dr 2 Dr 3 Dr 4 Practice Mean City Mean

21 Top 14 Referral Specialities for Dr /9 Referral per 100 sessions (Annual) 2010 Referrals per 100 sessions (Quarter) City Mean (2010) Brighton and Hove Integrated Care Service Limited (Company Number ) registered in England and Wales. Registered offices at First Floor, Prestamex House, Preston Road, Brighton, BN1 6AG. Telephone:

22 Obstacles and barriers GP colleague resistance Consultant resistance Pulling revenue / fixed costs out of acute trust PCT processes Multiple system entry points

23 Federated model championed by clinicians (RCGP Roadmap for General Practice Sept 2007) Systematic functions of a GP Federation: Improving health and equity Early diagnosis and problem definition Comprehensive and accessible services Navigation and integration of care Quality and safety systems Commissioning and Resource management Corporate functions Teaching and research Aggressive long-term condition management Practic e Team Practic e Team Practic e Team Communit y Network & Facility Practic e Team Diagnosis, enhanced services, ambulatory care provided by specialists and generalists Practic e Team Practic e Team

24 Elements of further integration Clinical integration: bringing together different kinds of expertise and interventions into teams of primary and secondary care clinicians e.g. through co-location or coemployment; Financial integration: bringing resources together in order to create a locus of accountability closer to patients, by various means, including delegation to providers of a risk capitation sum for a group of registered patients.

25 BICS local partnerships Dermatology Brighton and Hove Skin Care 1.02m MSK Brighton & Hove Musculoskeletal ICATS 2.05m Community Eye Service Community Gynaecology service Community Pharmacy Anti-Coagulant Monitoring service

26 Delivery model for elective dermatology and MSK outpatient services Primary Care Return to practice Gateway Practice B Practice A Practice C Extended Community Primary care Services Services Secondary Care

Long-stay patients methodology Published by NHS England and NHS Improvement

Long-stay patients methodology Published by NHS England and NHS Improvement July 2018 1 Document Title: Long-stay patients methodology Version number: 1.0 First published: 9 July 2018 Updated: Prepared