Ian Rutter

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Examples of integrated care systems from UK
Ian Rutter
GP, Clinical Advisor to Policy and Strategy
UnitDepartment of Health
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Planned Care in Community Settings Dr Ian Rutter
OBE
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Summary

• Vision
• Setting the scene
• Example models of integrated care
• Making it happen
• Using the Reform Agenda
• Conclusion

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Vision

• Vertical integration of care
• High quality care delivered in the most
  appropriate clinical settings as part of a
  co-ordinated, seamless clinical pathway
• Clinical staff working together
• Patient Choice, patients as customers

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218,281 appointments per annum in the community
Scale of Services
Extended provision in Bradford
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Extended Provision at Westcliffe
gt10,000 appointments per annum in the community
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Models of Care Westcliffe/Bradford

• Urology
• Dermatology
• Cardiology
• SOAP
• Diagnostics

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Urology Haematura Pathway
List Resection
Painless blood in urine
Consultant Review
Flex Cysto GPwSI
Radiology

• 1200 total number per year
• Integrated governance consultant/GP
• Contact Mr M Flannigan, Bradford Hospital for
  further information

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Dermatology

• GPwSI
• Consultants Dermatologists
• 26,000 Dermatology Appointments per year
• Monthly Joint Clinics
• Ongoing Training/ Diploma Dermatology
• Minor Surgery /Plastics Community Service
• Rapid Access Pigmented Lesion Clinic
• 40 50 Discharged no onward referral
• 11 Biopsy / Excision
• 11 Joint Consultant Review
• 30 - 40 Reviewed GPwSI
• Contacts Dr Andrew Wright, Bradford FT
• Dr Mary Cuthbert, Westcliffe Surgery
• Dr Ian Rutter, Department of Health

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SOAP

• Specialist Optometrist
• 60 Referrals Do Not Require Further Referral
• Direct Access Optometrist ? Cataract Surgery
• Rapid Treatment 2nd Eye
• Contact Dr John Bibby, Windhill Green, Medical
  Centre

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Cardiology
GP referral via Choose and Book, fax or post

• Full package (inc Consultant)
• Direct access investigations- Echo- 24hr BP-
  24hr ECG- routine ECG

• List for surgery
• Discharge
• Complex further management

• Cardiologist Direct listing to cardiac surgical
  list
• Contact Dr S Lindsey, Bradford Hospitals
• Dr M Fay, Westcliffe Surgery

• GPwSI with Consultant support
• Clinical protocols
• Service description
• Cost per case tariff
• Pick and mix options
• Maximum waiting times GPwSI 2 weeks
• Maximum waiting times consultant 4 weeks

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Number of referrals/activity done 14 May 07 31
Aug 07
Case Mix
524 appointments in the community setting in gt
4mths
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Diagnostics

• Direct access protocol
• Symptom driven complexes at ISTC
• NICE guidelines
• Test in parallel, not series
• Direct access MDT meetings
• Plexus Holland

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Assuring fitness for purpose
Accreditation
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Making it happen

• Win Win focus on the patient/clinical journey
• Culture of innovation remove prejudice
• Information focused, timely, transparent,
  benchmarked
• Science of improvement
• Care pathway mapping
• Small cycle changes
• Removing unnecessary steps
• Control charts/ sampling
• Patients/Care Pathway Mapping/Satisfaction
• Best Practice, NICE, etc
• Constant continuously improving system

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Using the Reform Agenda

• Commissioning PCT / PBC role
• Strategic needs assessment
• Encouraging any willing provider
• Facilitating clinical networks/developing local
  collaboratives/protocols of care/involving
  patients/market development
• Local/national Choice menus
• Audit data on Choice menus
• Cost per case contracts

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Using the Reform Agenda

• Primary Care Organisational Models
• Integrated Vertical Care Models
• Secondary Care Organisations
• Practice
• Social enterprise/ other models
• PBC groups facilitated and helped to develop

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Conclusion

• Large scale shift of appropriate care into
  community settings is possible
• Culture of innovation using the science of
  improvement helps you to stay patient focussed
  and deliver
• Use the reform levers to maximise the impact
• Clinical networks and organisational mature
  competition are entirely compatible
• PATIENTS FIRST

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Contacts