ESTABLISHING PRACTICE BASED COMMISSIONING ACROSS REDBRIDGE PRIMARY CARE TRUST

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ESTABLISHING PRACTICE BASED COMMISSIONING ACROSS
REDBRIDGE PRIMARY CARE TRUST
.. Progress so far
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THE PROCESS
Launched early September 2005 Expressions of
interest 100 practices 3
clusters Preparatory LES (pLES) 100
take-up Standards for Better Health
workbooks 100 return rate Framework
Agreement November 2005 Business Cases 3
clusters to assessment panels November
2005 Approved by Board November 2005
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FUTURE PROCESS

• Memorandum of Agreement
• Between the PCT and the cluster (as an advisory
  committee of the PCT)
• Between the practices within a cluster (term of
  engagement)
• Commissioning Intentions
• Service redesign business proposals

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CLINICAL ENGAGEMENT the PCTs view
Building upon Locality commissioning Partnership
Working the umbilical cord Monthly joint
PEC/PbC Management Team facilitated sessions pLES
Development Programme for all practices PCT
Officers / PbC Leads meetings
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CLINICAL ENGAGEMENT the clinicians view

• Why GPs should become involved - Dr Henry Akpabio
• How will the clusters ensure active
• practice engagement - Dr Narinder Sharma
• What its really been like working
• with the PCT - Dr Richard Price
• How PbC will build on what has
• gone before - Redesigning the front
• door of A E - Dr Hector Spiteri

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CLINICAL ENGAGEMENT the clinicians view

• Why GPs should become involved - Dr Henry
  Akpabio
• How will the clusters ensure active practice
• engagement - Dr Narinder Sharma
• What its really been like working with the PCT
  - Dr Richard Price
• How PbC will build on what has gone before
• - Redesigning the front door of A E - Jane
  Mehta
• Dr Hector Spiteri

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Dr Henry AkpabioWhy should GPs become involved?

• GPs spend most NHS cash so best placed to manage
  demand
• We are providers and commissioners
• gt Influence what, where and how services
  should be delivered
• gt Ensure patients have choice
• We are best placed to redesign pathways
• gt What should be done outside of hospital
• gt Bring services closer to patients
• gt Freedom to innovate
• gt Match service provision to
  local needs
• Failure to participate
• gt Will happen without you so be in the driving
  seat
• gt Missed opportunity to make real service
  change

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Dr Narinder SharmaHow will the clusters ensure
active practice engagement?

• Clusters organically evolved
• Principles of engagement agreed with practices
• gt Openess transparency and inclusion
• gt Principles will inform future
  governance arrangements
• Ensuring practical engagement
• gt Cluster Steering Group meetings open to all
  practices
• gt Practical engagement through working groups
• gt Regular meetings of the whole cluster
• Ensuring support and development at practice
  level
• gt pLES PbC Local Enhanced Service
• gt Participation in programme modules

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Dr Richard Price What its really been like
working with the PCT

• Historical Relationships
• gtEasy to separate clinicians and management
• Why Change Relationships?
• gt Will PbC work?
• gt Partnerships will turn clinicians ideas to
  reality
• gt Management puts the nuts and bolts in
  place to enable real change
• How do clinicians feel in Redbridge?
• gt Encouraged and supported
• gt Professional Management in place
• gt Progress co-ordination across the clusters
• Acquaintance to Engagement to Real
  Partnership Working
• Service Redesign
• gt A E Activity and Admissions identified as a
  priority for clusters
• gt Signed up to Redesigning the front door of
  AE project

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The front door of King Georges A E the facts

• 110K attendances per year and rising
• Attendance to admission ratio of 19.7 and rising
• 3 entrances to AE adult, children and resusc
• OOH situated in out patients
• 50 Redbridge, 28 BD, 22 other PCTS
• Of Redbridge patients
• 20 arrive by emergency ambulance
• 72 arrive by own car
• 8 arrive by walking, taxi, friends etc
• 18 attendances 65 year plus
• 30 attendances 16 years or under (7.3 admitted)
• 22 of attendances aged 17 plus were admitted
• 494 patients attended 6 or more times in one year
• 94 attended 10 or more times in one year
• Monday is the busiest day
• March is the busiest month
• GP in AE pilot suggests that 50 of AE
  attendances were with minor injury or illness

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The future gateway

• Have one gateway (except for blue lights)
• Treat immediately and reduce triage substantially
• Maintain separate child facilities
• View model on a health economy not just on a
  hospital basis
• Include mental health, OOH and ECPs as part of
  gateway eliminate several separate teams and
  have one gateway team
• Integrate Ilford WiC
• Stream non urgent cases straight back to primary
  care
• Manage and treat simple cases in fastest way
  possible
• Manage further assessment and referral on to
  specialist intervention if appropriate
• Facilitate non registered patients to register
  with practice there and then
• Provide health promotion advice and self
  management and education
• Support staff around frequent non urgent users

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Dr Hector Spiteri

• SHA objective for clinicians to manage risk and
  change
• Managing admissions and A E waiting times
• Primary Care Clinicians Seeing and Treating
• - Efficiency and effectiveness
• - Impact on admission rates
• Throughput
• Developing a Treat model