s141 – day 1 – 1545 – closing the gap between primary and secondary care
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Health and Care Innovation Expo 2014, Pop-up University S141 – Day 1 – 1545 – Closing the gap between primary and secondary care Bridget Fletcher Dr Richard Pope #Expo14NHSTRANSCRIPT
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closing the gap between primary &
secondary care
Bridget Fletcher, Chief Executive, Airedale NHS FT
Richard Pope, Hon Consultant Physician, Airedale NHS FT
Colin Renwick, Chair, Airedale Wharfedale and Craven CCG
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Is there a Gap between primary and secondary care?
Gap…what gap?Is there a gap between primary & secondary care?
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Through their eyes…
“… I saw 3 different doctors in as many weeks and had to retell my story each time…”
“…communicate with everyone who supports me…”“…the systems work for systems not for individuals…”
“…catch me on a low day and support me…”“…no one asked me what was important to me…”
“…clinical priorities may not be my priorities
“…I don’t want to wait for a doctors appointment , I want to talk to someone immediately…”
“…need some way of checking where my prescription is and tracking its progress…”
“…have to keep repeating my story…”
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stressed clinical staff
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The need for changeThe need for change is compelling – the standard drivers include….
cost: an estimated 20% of healthcare spend is wasted on overuse,
misuse or underuse of care 72% of discretionary spend is controlled by the Doctor’s pen unprecedented efficiency challenges
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The need for changeThe need for change is compelling – the standard drivers include….
complexity:
multimorbidity, including cognitive impairment, has become the “norm”
demand, particularly in the LTC area, is increasing rapidly
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The need for change
The need for change is compelling – the standard drivers include….
quality:
the delivery models of the past are in many cases no longer fit for purpose measurement of quality is by silo – not really by users’ experience
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The need for change
inertia:
failure to recognise these issues underpins much of the “aversion to change” in the NHS
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close - or FILL - the gap?
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Our Vision
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The guiding principle of our shared vision
“ whilst commissioners and providers are responsible for whole populations, it will be our shared focus on meeting individual need that will define us.
This individual focus lies at the very heart of the delivery of ‘Right Care’….”
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The dialogueLocally – series of very constructive meetings Primary:Secondary care
Enthusiasm
Sense of urgency and ability to move
Key element – Shared EHR as a tool for transformationgenerate the win:win
e-discharge
e-prescribing
MSK pathways across org boundaries
GUMCommunity services…..
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Is this enough?
….the ‘aggregation of marginal gains’. Put simply….how small improvements in a number of different aspects of what we do can have a huge impact to the overall performance….
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e-Consultation use May 2010 to March 2013 - Bradford , Dr J Connolly
Ma Ju
lSep Nov Ja M
arM
ay Jul
Sep Nov Ja Mar
May Ju
lSep Nov Ja M
ar0
20
40
60
80
100
120
140
Rheumatology
Nephrology
Haematology
Hepatology
Endocrinology
Diabetes
Cardiology
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Immediate access to……immediate
access
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teleconsultation
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in primary care
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Care Homes - summary
0
100
200
300
400
500
600
700Acute Admissions 1Year Prior toDeployment ofTelemedicine
Acute Admissions 1Year PostDeployment ofTelemedicine
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The guiding principle of our shared vision
“ whilst commissioners and providers are responsible for whole populations, it will be our shared focus on meeting individual need that will define us.
This individual focus lies at the very heart of the delivery of ‘Right Care’….”
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how will we know what people
want/need – unless they tell us…
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The person orchestrating their own care with clinicians working by exception
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Closing the gap: where to start?
Need to secure GP and consultant confidence in the benefits of collaboration
A clear articulation of what the benefits (and risks) of collaboration are?
Mutual understanding and respect on both ‘sides’
Focus on what is (should be!) of importance to clinicians:
- getting the best clinical outcomes for our patients (no brainer)- getting the best value-based healthcare / use of resource in AWC)
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Closing the gap: where to startChanging behaviours – taking responsibility for system resource – an OD Piece:
Hospital – ‘do I really need to admit’ – do I know what’s available in primary care
can I be bothered to pick up the ‘phone (use
SystmOne!!) to discuss with my primary care partner
GP – ‘do I really need to refer’ – could I use an alternative – can I
be bothered to spend
the time finding that alternative”
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Clinical service collaboration ‘gap’ interface
AWC Federations /
practices
Delivering primary care
Interface (gap) opportunities:
MusculoskeletalGenitourinary medicineSubstance misuseCommunity servicesWhat else?
ANHSFT
Delivering secondary
care
Our shared Right Care STRATEGIC AIM: to blur the care delivery boundaries further and this gap to narrow?
Patient experience across AWC becomes SEAMLESS
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Filling the Gap: Health Economy Clinical Boards
Membership: GPs/Consultants/Public Health Physicians/Lay
Focus on high impact / high spend (PHE data) / quality issues
Each Board co-designs / agree pathways and resource utilisation
?Cancer services?LTC / multi-morbidity?Vascular (CVS/Stroke/DM)
Core outputs: Patient Experience & evidence of QI
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Filling the GapWhat does this mean?
Hospital staff in primary care and vice versa. Locally designed and owned approaches
Rich Clinical Data will facilitate better clinical decision making
There must be (effectively) a “single” patient record
Our Patients will make a huge contribution to the signalling that triggers response from the system
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Filling the GapWhat does this mean?
Technology, not transport, will bring teams together
Pathways will be compressed.
This will decrease, not increase, work in the system
Clinicians’ working day will look very different
Our Patients will have a (much) better experience of care
Costs of care delivery, particularly for LTCs, will reduce
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Filling the Gap continued
In order to work at real scale
What will the organisational forms look like ?
What will commissioning look like?
What will payment systems need to look like?
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