Doncaster Health Community

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Doncaster Health Community
How to Develop Clinical Pathways Across Providers
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Julie Butler 18 week Project Manager
Doncaster PCT Alaina Challans Change Manager
Doncaster PCT Anthony Fitzgerald Service
Improvement Manager - Doncaster and Bassetlaw
Hospital NHS Foundation Trust
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HOW SPECIALTIES ARE IDENTIFIED

• 18 weeks Steering Group
• Practice Based Commissioning

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SPECIALTIES IDENTIFIED IN DONCASTER

• Orthopaedics 18 week Steering Group
• ENT 18 week Steering Group
• Paediatrics( Phased Approach) - PBC
• Dermatology - PBC
• Ophthalmology PBC
• Physio PBC
• Orthodontics 18 week Steering Group

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RE-DESIGN PROCESS

• Establish a working Group identify key members
  i.e PBC Lead, Senior Management, finance,
  Clinical representation from both Primary and
  Secondary care
• Commence PPI Process
• Agree TOR and Objectives

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RE-DESIGN PROCESS

• Develop Pre-Business Case
• Submit Pre-Business Case to PCT Commissioning
  Executive
• Develop Full Business Case
• Develop Service Specification
• Finance and Procure go out to Tender

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ENT CATS ( CLINICAL ASSESSMENT TREATMENT
SERVICE)

• Members
• 2 x PCT reps (1 clinical 1 commissioner)
• 1 x rep from each consortia (all clinicians)
• 3 x DBH reps (1 ENT consultant, 2 senior
  management)
• Mapping
• Clear bottleneck at first appoint for any ENT
• Everything was going through a consultant

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Referral Review

• Reviewed 1 months referrals
• Established 44 of patients could be treated
  without consultant intervention
• Identified preferred model

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IDENTIFIED PREFERRED MODEL

• ENT CATS
• Adult services Hearing, Aural care, Nasal
  obstruction, Throat
• Children service - Throat

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NEW PATHWAYS

• Sits in primary care with patient choice for
  onward referral
• Use of nurse practitioners, audiologists,
  speech language technician
• Use of video capture technology for virtual
  clinics
• 2 consultant sessions/week

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BUSINESS CASE

• Based on speed to first appointment rather than
  care closer to home or cost savings
• Built in capacity to address waiting list
  pressure future growth
• Supported by specific Referral Proforma

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BUSINESS CASE

• Allows for 6 month consultant filter of
  referrals for appropriate directing
• Built in Standards for Better Health
• Financial modelling showed a saving of 339k
  over 3 years
• Capacity for 94 patients each week

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WHERE ARE WE?

• Commissioning Executive decided on a single
  tender process
• Service Spec is out to tender and bid is due
• Referral proforma in draft and will go to GPs
  for agreement

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WHAT HAVE WE LEARNT- PCT?

• Use a large capture of referrals (for other
  areas outcomes may be more important)
• Engage with patients at an early stage
• Ensure all parties are clear about establishing
  a pathway, not creating a business opportunity
• Keep it simple

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GP REFERRING TO ENT CATS
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PROFORMA
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WHAT HAVE WE LEARNT - TRUST?

• It is a threat.
• Need to identify Clinicians to drive the
  redesign show the benefits to them.
• Need to adapt your capacity to meet the new
  demand. e.g. More Surgery instead of clinics
• Your follow up rate will increase. Again adapt
  capacity accordingly

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WHAT HAVE WE LEARNT - TRUST?

• Must code correctly when did treatment happen?
• Admin Processes crucial
• Focus on the Patient Quality
• Important to clear backlog of patients waiting
  while redesign is going

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Performance.