Future of Specialist Services in Primary care

1
Future of Specialist Services in Primary care

• Minoo Irani
• Network Lead Specialists in Primary Care
• NHS Alliance

2
Specialist Services in Primary Care

• Community Paediatrics
• Medicine for the elderly
• Genitourinary Medicine
• Diabetes services
• Dermatology
• Mental Health
• Learning Disability services
• And more!

3
Commissioning a patient-led NHS

• 28 July 2005 Alarm Bells
• Secure services from a range of providers.
  Contestability
• 26 August Phew!
• Discussion on provider functions to begin after
  PCT restructuring
• 25 October What?
• Individual PCTs to decide future of provider
  services

4
SWOT/TOWS

• Threats
• Opportunities
• Weaknesses
• Strengths

5
Threat to Specialist services

• Risk disintegration of existing teams
• Uncertainty about provider organisations
• Rapid pace of change
• Staff morale affected adversely
• Disruption to current good practices
• Losing some components of services during
  reorganisation

6
Opportunities

• White Paper (Health outside hospital)
• Practice Based Commissioning
• Childrens Trusts/Care Trusts
• Clinical autonomy in Primary Care
• Unmet patient needs
• Modernisation/innovation

7
Weaknesses

• Small numbers of specialists in Primary Care
• Experience of success of masterful inactivity
  (clinicians?)
• Reluctance to spend time on non-clinical issues
• Professional/Service barriers (GP/Consultant
  Primary/Secondary Care)

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Strengths

• Frontline clinicians
• Most responsive to patient needs
• Knowledge monopoly
• Experience of working with Primary and Secondary
  Care
• Good relations with social care/ voluntary sector

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The Future

• Consider Options
• Networking/debate options
• One size never fits all
• Share good practice examples
• Inform policy makers

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Option 1 status quo

• Pros
• 1.Least disruptive to staff and services
• 2.Build upon current success in small steps
• Cons
• 1.Missed opportunity for innovation
• 2.Renew ties with new reorganised PCTs

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Option 2 Integrate with Secondary Care

• Pros
• 1. Prior experience working in hospital
• 2. Avoid professional isolation
• Cons
• 1. Links with Primary and social care may be
  compromised
• 2. Unknown pressures of working in Foundation
  Trust Hospitals with emphasis on savings

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Option 3 Primary Care Centres

• Pros
• 1. Maintain links with Primary Care
  commissioners to benefit services
• 2. Greater clinical autonomy and clinical
  priorities determine services
• Cons
• 1. Untested model based on GP practice
• 2. Perceived loss of Consultant status

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Option 4 Integration with Social Care

• Pros
• 1. Joint working for benefit of patients
• 2. Seamless care pathways between health and
  social care
• Cons
• 1. Untested model of social care as employers
  for medical staff
• 2. Concerns about lines of accountability,
  clinical governance, NHS Pensions

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Option 5 Private Providers

• Pros
• 1. Improved efficiency in some situations
• 2. Financial rewards for excellence
• Cons
• 1. Perverse business incentives may affect
  patient care
• 2. Low profit services could get marginalised

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Conclusions

• Change is inevitable
• To lead or be led?. that is the question
• Masterful inactivity until 2008 is a risky option
• Change always offers opportunities and threats
• Keep best interest of patient in mind
• Consider the option to boldly go where no one
  has gone before

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Next Steps

• Questions
• Debate
• Networking