Primary and Integrated Care Directorate

1
Primary and Integrated Care Directorate

• Board briefing September 2004

2
Scale of the Directorate

• Directorate formed on 1.2.04
• Registered patients 308,000 (registered with 50
  GP practices)
• Staff 1130(949 wte) employed 72 PCT workforce
• Assets 11 Health Centres/clinics, Putney
  Hospital site and QMH

3
Budget

• Budget of approx 95m made up of
• Community services 16.4m
• Integrated Care 26.5m
• Prescribing 30m
• Primary Care (PMS/GMS etc) 22m
• (Plus SSP costs and capital charges )

4
Role of the Directorate

• The Directorate has an overall aim to improve the
  health of the population we serve, and three main
  functions
• 1.  Delivery of high quality, equitable and
  accessible primary care and community services
• 2.   Performance-management and regulation
  (through the contractual relationship) of
  independent Primary Care contractors (GPs
  Dentists, Optometrists and Pharmacists)
• 3.  Supporting and developing practice and policy
  in primary and community care in all areas  

5
PCT Provided Services

• Community Nursing -health visitors, district
  nurses, school nurses
• Therapies - Speech and Language, Physiotherapy,
  Occupational therapy, dietetics, podiatry
• Inpatient services for older people and
  rehabilitation at QMH
• Wheelchair, special seating and orthotics
  services
• QMH outpatient and Diagnostic Services
• Limb fitting and rehabilitation
• Community Dental services (across both Wandsworth
  and Sutton and Merton PCTs)
• Intermediate care community team and inpatient
  beds
• Pan PCT services e.g Family Planning continence,
  Free Nursing Home Care Haemoglobinopathies,
  Equipment Loans
• Safeguarding Children
• Child Health Records
• Out of Hours Primary Care services including the
  Walk In Centre,Minor Injuries Unit and OOH GP
  service.
• Partnership services in 2 Healthy Living centres,
  2 SURESTARTs Childrens centre and 1 Extended
  School

6
(No Transcript)
7
Mapping the asteroids Impacts on the
Directorate 2003/4

Mapping the Asteroids
CHI
New GMS Contract
New Dental contract 2005 devolved commissioning  
IMT Pan London LSP new systems
Sexual Health Strategy
Childrens NSF
Childrens Green Paper

NSF targets
Prison Health
Star ratings targets
PPI -PALS /patient forum
GP R and R
GP appraisal /revalidation
LHE finances
QMH d development
  Wandsworth PCT
New pharmacy contract
Out of Hours services and targets
Expert patient
New GP contract
PCT finances
NICE
RR
Epsom Ortho Centre
Workforce planning
Putney PCC
Commissioning of Primary care services
LA Overview and Scrutiny
Patient Choice
Premises/LIFT
Free Nursing Care
Integrated Continence Service
Integrated comm. Equipment
DDA premises issues
Population Demographics Workforce time bomb
Agenda for Change
Patient Expectations
8
Hot issues for the current year

• QMH Development
• Agenda for Change
• NPfIT ,choose and book etc
• Activity recording and records management
• Out of hours and emergency care interface
• Intermediate care expansion
• Preparing for commissioning Dentistry and new
  Pharmacy contract
• Integrating and reviewing School Nursing services
  
• Chronic Disease management
• Future of community Nursing

• Financial balance and CIPs
• New GP contract especially Commissioning of
  enhanced services OOH and QOF
• Child protection post-Climbie Childrens NSF/Green
  Paper /Childrens Trusts
• Single Assessment Process for Older people
• Integrating Continence and Equipment Services
• Sexual Health strategy and Family Planning
• StJTC and Putney PCC developments
• Emergency Planning

9
Ongoing challenges

• Premises improvements and funding
• IT in the interim pre-NPfIT era and implementing
  NPfIT
• Staff recruitment, retention and training (and
  impact of new roles on whole workforce)
• Access to services
• Inequity of health and service provision
• Engaging and involving clinicians
• Providing/commissioning community based
  continuing care packages.

• Performance quality and Star Ratings improvements
• Delivering the PPI agenda at the front line
• Fully embedding the diversity agenda into
  services
• Meeting Patient Expectations
• Enabling the acute service shift to
  primary/community settings
• Clinical Governance,Risk Management and HCC
  Inspection

10
Some of our achievements

• Provider services in top 20 of PTS in balanced
  scorecard part of star rating assessment
• flu immunisation target met
• WW South Locality sharing good practice event "
• Footsteps to Healthy Living (Tooting) Programme
  launched in February 2004
• Community Diabetes Education Programme
• Homeless peoples team win Health Excellence
  award
• 3 new GP developments opened and more underway

• All GP principles have received appraisals
• Transfer of School Nursing, Paediatric OT and
  Family Planning
• Integration of community equipment services with
  Local Authority and formation of continence
  consortium with other PCTs re-tendering has
  doubled capacity and is cost neutral
• Consistent prescribing savings
• Child protection self assessment tool workshops
  and training delivered across PCT
• Successful bid for 246k to set up low vision aids
  service

11
Achievements - continued

• Roehampton Surestart and Tooting Graveney
  Childrens Centre established, Battersea Surestart
  expanded
• Find a Doc scheme launched ( Find a Dentist
  scheme coming soon )
• New GMS contracts signed on time
• Over 5000 patients per year now receiving
  outpatient care through a Rapid Diagnostic
  Package
• Successful installation of a new CT Scanner which
  significantly improved waiting times and local
  access

• Introduction of an Inter-professional training
  ward at QMH for pre-registration medical, nursing
  and therapy students
• The introduction of computer aided design and
  manufacture (CADCAM) technology into the
  Prosthetic and Orthotic services which has
  reduced waiting times and improved quality of
  care
• Improvement in Primary Care access to 97 (now
  100)
• PCT Emergency plans reviewed and revised

12
Examples of work in progress

• New structures and work to improve records
  governance
• Review of current community information systems
• Use of bank and agency staff - review in
  progress
• Project to re-design and modernise some parts of
  the SLT service to improve waiting times
• Evaluation of Evercare and ECP roles and
  participation in Physician Asst pilot
• Planning the move to new QMH

• Primary Care Commissioning Group established and
  developing local enhanced service specifications
  for sexual health services, smoking cessation,
  ethnicity monitoring, mass vaccination
• Assessment of the Quality and Outcomes Framework
  - mechanism set up
• Piloting of self managed nursing teams in P and R
  

13
More examples of work in progress

• Community Dental Service
• In partnership with SGH development of a care
  pathway for patients who are dental phobic.
• Review options with SGH for the development of a
  care pathway for paediatric patients, including
  access to GA facilities
• Installation of specialist units to facilitate
  provision of dental care for patients in
  wheelchairs (funded by SGH special trustees)

• Community pharmacy developments
• Working towards a joint primary/ secondary care
  formulary
• Work with Palliative care services,
• The minor ailments project,
• Nightingale house pharmacy services improvements.
  
• Involving community pharmacists in smoking
  cessation (40 trained)
• Now part of smoking cessation collaborative