PRIMARY CARE DEVELOPMENT

1

• PRIMARY CARE DEVELOPMENT
• QUALITY STANDARDS OUTLINE FRAMEWORK FOR
  DELIVERY
• Keith Parsons
• Assistant Director Primary Care Commissioning

2
BACKGROUND

• ACCESS ACTION PLAN
• FOCUS ON QUALITY IMPROVEMENT
• NEED FOR BETTER PERFORMANCE MONITORING
• NATIONAL POLICY DIRECTION
• LOCAL POLICY CONTEXT
• GP AGE PROFILE AND PRACTICE STRUCTURES
• DARZI REVIEW

3
PROCESS

• PEC DISCUSSION ON WIDER ACCESS ISSUES IN
  SEPTEMBER 2007
• WORKING PARTY COMMISSIONED TO PRODUCE QUALITY
  STANDARDS DELIVERY FRAMEWORK
• THREE MEETINGS OF WORKING PARTY
• PAPER TO DECEMBER PEC
• DIRECTION APPROVED BY PEC AND REFERRED TO
  LOCALITY BOARDS AND PCT BOARD IN JANUARY
• ASSUMING GENERAL APPROVAL, IMPLEMENTATION PLAN TO
  PEC IN FEBRUARY

4
PRIMARY MEDICAL CARE DESIRED CHARACTERISTICS

• The PCT wishes to commission services which
• Are of high quality, supported by robust quality
  measurement
• Offer safe, clinically effective, evidence-based
  treatment
• Are accessible to patients 7 days a week 8am
  8pm
• Are provided from purpose-built premises in
  strategic locations
• Offer real choice to patients
• Offer Patient Centred, personalised care
• Are provided by a highly skilled and qualified
  workforce
• Represent very good value for money

5
QUALITY INDICATORS BALANCED SCORECARD

• Compliance with HCC Standards
• Statutory Contractual Requirements
• Environment (Buildings, Infection Control)
• Access to Medical Services
• Range of Services Available
• Quality of Services Provided
• Clinical and Cost Effectiveness of Prescribing
• Patient Involvement

6
SCORECARD MECHANICS

• Each indicator banded A, B or C
• Largely compiled from PCT Held Data with some
  practice self-assessment
• No overall rating
• Final scorecard will show distribution of As, Bs
  Cs
• Objective is for all Contractors to score
  Straight As by April 2010
• Support and Development Plan agreed with
  contractors with too many Cs and Bs
• Ultimately may require sanctions if no positive
  move towards good scorecard outcome

7
SUPPORT TO CONTRACTORS

• THE PCT WILL OFFER A SUPPORTIVE ENVIRONMENT
  WITHIN WHICH THERE IS AN EXPECATATION OF HIGH
  QUALITY PROVISION
• A RANGE OF DEVELOMENTAL OPPORTUNITIES
• LOCAL INCENTIVES
• CUSTOMER CARE SKILLS TRAINING
• WORKFORCE PLANNING AND DEVELOPMENT
• HUMAN RESOURCES (HR) SUPPORT
• IT SUPPORT
• PROFESSIONAL DEVELOPMENT APPRAISAL
• RISK ASSESSMENT RISK MANAGEMENT

8
TIMESCALE

• CURRENT CONSULTATION WITH BOARDS LMC (End Feb)
• ALL PRACTICES BANDED AND SELF-ASSESSMENTS
  COMPLETE (End May)
• INITIAL ANALYSIS PRESENTED TO PRACTICES (End
  June)
• ACTION PLANS AGREED WHERE PERFORMANCE NOT MEETING
  REQUIRED STANDARD (End August)
• ROBUST MONITORING BEGINS (Autumn 2008)
• PROVIDERS NEED TO DEMONSTRATE HIGH LEVEL OF
  ENGAGEMENT (April 09 Onwards)
• EXPECTATION OF HIGH ATTAINMENT (April 2010)

9
THE DARZI REVIEW EQUITABLE ACCESS TO PRIMARY
MEDICAL CARE

• HULL PCT IS IN LOWEST QUARTILE NATIONALLY IN
  DOCTORPATIENT RATIOS
• THE PCT WILL THEREFORE RECEIVE FUNDING TO PROCURE
  THREE NEW GP PRACTICES OF AVERAGE SIZE
• EVERY PCT IS TO INTRODUCE A NEW GP-LED HEALTH
  CENTRE
• AT LEAST 50 OF PRACTICES TO OFFER EXTENDED
  OPENING HOURS

10
SOME STATISTICS

• NATIONAL AVERAGE GP LIST SIZE 1610 IN 2006
• HULL PCT AVERAGE LIST SIZE CURRENTLY 2035 (26)
• WORST LOCALITY (E) IS 2169 (35)
• SOME PRACTICES MORE THAN DOUBLE NATIONAL AVERAGE
  WITH POOR INFRASTRUCTURE
• NATIONAL AVERAGE 62.1 GPs per 100k POP
• HULL PCT IS 48.2 EAST LOCALITY IS 46.1
• HULL HAS 40 I.M.P. CONTRACTORS (22 FROM 55)
• AVERAGE AGE OF 22 IMPs IS 61.3

11
DARZI GP PRACTICES

• CORE GP SERVICES
• AT LEAST 6000 PATIENTS
• EXTENDED OPENING
• ACCREDITED TRAINING PRACTICE WITHIN 18 MONTHS
• ENGAGED IN PBC
• WIDER GEOGRAPHICAL BOUNDARIES

12
NEW GP PRACTICES

• PCT CONSIDERING FURTHER FUNDING TO ADD TO THE 3
  NEW PRACTICES FUNDED BY DARZI
• THE NEW PRACTICES WILL HAVE APMS CONTRACTS THAT
  WILL REQUIRE ALL THE QUALITY STANDARDS IN THE
  BALANCED SCORECARD TO BE DELIVERED AS PART OF THE
  CONTRACT TERMS
• A MUCH HIGHER PROPORTION OF CONTRACT FUNDING WILL
  BE RELATED TO PATIENTS AND PATIENT EXPERIENCE

13
DARZI GP LED HEALTH CENTRE

• CORE GP SERVICE
• INTEGRATED WITH OTHER SERVICES
• EASILY ACCESSIBLE LOCATION
• OPEN 8am TO 8pm 7 DAYS A WEEK
• OFFER PRE-BOOKABLE APPOINTMENTS AND WALK-IN
  SERVICE
• OPEN TO REGISTERED AND NON-REGISTERED PATIENTS

14
NEW PRACTICE LOCATIONS

• SUBJECT TO CONSULTATION THE FOLLOWING ARE
  POTENTIAL SITES
• KINGSWOOD
• BRANSHOLME
• HOLDERNESS ROAD
• ORCHARD PARK
• CITY CENTRE
• SPRINGHEAD

15
NEWLY PROCURED PROVIDERS WOULD

• OFFER A MUCH WIDER RANGE OF CORE SERVICES
• OFFER WIDER ACCESS AND CHOICE
• NOT BE PERMITTED TO CLOSE THEIR LIST
• GUARANTEE ACCESS TO FEMALE CLINICIANS
• ACT AS A CATALYST FOR RECONFIGURING LOCAL GP
  SERVICES
• FOSTER POSITIVE RELATIONSHIPS WITH PATIENTS
• COMPLY WITH ALL NATIONAL POLICY INITIATIVES
• SET A BENCHMARK WHICH ALL PROVIDERS WILL NEED TO
  MEET EVENTUALLY

16
DARZI MILESTONES 2008
17
CONCLUSION

• THIS POLICY APPROACH IS DESIGNED TO IMPROVE THE
  QUALITY OF LOCAL SERVICES FOR THE BENEFIT OF
  PATIENTS
• ACCESS, CHOICE THE RANGE OF SERVICES AVAILABLE
  WILL INCREASE, ALTHOUGH THE NUMBER OF GP SITES
  WILL REDUCE
• THE PCT IS USING THE MODEL TO RECONFIGURE GP
  SERVICES INTO A MODEL MORE SUITED TO THE 21st
  CENTURY