Primary Care in the United Kingdom Dr Mike Burrows Chief Executive - - PowerPoint PPT Presentation

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Primary Care in the United Kingdom

Dr Mike Burrows

Chief Executive Salford Teaching Primary Care Trust

“adding life to years and years to life IN Salford”

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• United Kingdom four separate healthcare

systems

• England

– 152 Primary Care Trusts

• A financial allocation direct from central

government

• PCTs

– Commissioning of services – Provision of services – Public Health role

Primary Care Background

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Where is Salford?

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• 230,000 population
• A post industrial city
• 35% of ward areas are in the 10% most

deprived in the country

• PCT co-terminous with local government

Salford

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Salford – Male Life Expectancy

68 69 70 71 72 73 74 75 76 77 78 1995/96 2002-04 2003-05 2004-06

Years

Salford England

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Salford – Female Life Expectancy

75 76 77 78 79 80 81 82 1995/96 2002-04 2003-05 2004-06

Years

Salford England

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• Heart Disease & stroke in under 65s – 151
• Stroke – 137
• Cancers

– Colon – 126 – Lung – 180 – Oesophagus – 153 – Stomach – 132

• Anti-depressants 1/3 above

national average Salford – A Few Health Statistics Standardised Mortality Ratios (SMRs)

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Primary Care in Salford

• 53 GP Practices
• 155 doctors
• Practices

– Separate organisations – Partnerships or sole traders

• Contractual relationship with the PCT as

commissioner

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Features of the GMS Contract

• Core contract based on population size
• Performance based component

– 3 domains

• Clinical
• Organisational
• Patient experience
• Specific funding for additional services

– National – Local

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Quality & Outcomes Framework (QOF) Clinical Indicators

Secondary prevention of coronary heart disease Cardiovascular disease – primary prevention Heart failure Stroke and Transient Ischaemic Attack Hypertension Diabetes mellitus Chronic obstructive pulmonary disease Epilepsy Hypothyroid Cancer Palliative care Mental health Asthma Dementia Depression Chronic kidney disease Atrial fibrillation Obesity Learning disabilities Smoking

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Quality & Outcomes Framework (QOF) clinical domain examples

• Percentage of patients with coronary heart disease in

whom the last blood pressure reading is 150/90 or less

• Percentage of patients with coronary heart disease

whose last measured total cholesterol is 5mm/l or less

• Percentage of patients with hypertension in whom the

last blood pressure reading is 150/90 or less

• Percentage of patients with diabetes in whom the last

blood pressure reading is 145/85 or less

• Percentage of patients with diabetes in whom the last

HbA1c is 7.5 or less

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Quality & Outcomes Framework (QOF) Organisational Domain

• Records and information
• Information for patients
• Education and training
• Practice management
• Medicines management

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Quality & Outcomes Framework (QOF) Patient Experience Domain

• Length of Consultation
• Access to a Primary Care Professional

within 24 hours

• Access to a GP within 48 hours

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Analysis of GP Practice Size in Salford

2 4 6 8 10 12 14

• 1

1 1

• 2

2 1

• 3

3 1

• 4

4 1

• 5

5 1

• 6

6 1

• 7

7 1

• 8

8 1

• 9

9 1

• 1

1 1

• 1

1 1 1 1

• 1

2 1 2 1

• 1

3 1 3 1

• 1

4 Number of Patients Frequency

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Number of GPs within Each Practice

2 4 6 8 10 12 14 16 18 20 1 2 3 4 5 6 7 8 9 GPs Frequency

16 List Size (Number of Patients Per GP)

1 2 3 4 5 6 7 8 9 10

• 2

5 2 5

• 5

5

• 7

5 7 5

• 1

1

• 1

2 5 1 2 5

• 1

5 1 5

• 1

7 5 1 7 5

• 2

2

• 2

2 5 2 2 5

• 2

5 2 5

• 2

7 5 2 7 5

• 3

3

• 3

2 5 3 2 5

• 3

5 Patient Numbers Frequency

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List Size (Number of Patients Per GP)

1 2 3 4 5 6 7 8 9 10 0 - 250 250 - 500 500 - 750 750 - 1000 1000 - 1250 1250 - 1500 1500 - 1750 1750 - 2000 2000 - 2250 2250 - 2500 2500 - 2750 2750 - 3000 3000 - 3250 3250 - 3500 Patient Numbers Frequency > 1 GP Single GP

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Domain Maximum Available Points 2008/09 Points Achieved 2008/09 % Points Achieved 2008/09 Clinical 36,400 32,883 90.34% Organisational 9,380 7,785 82.99% Additional services 2,016 1,724 85.53% Patient experience 8,204 6259 76.29% Total 56,000 46,242 82.58%

QoF Points – Performance of Salford GPs

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Coronary Heart Disease 8 2008/09

% of patients with Coronary Heart Disease whose last measured total cholesterol (measured in the previous 15 months) is 5 mmol/l or less. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Gore H Leach G Locum To Dr Chowdhury(Jeet II) Davis Ws Borg-Costanzi Jm Larah Dg Sinha Rp Levenson S Rolfe Jn Tauk T Drs Nagesh & Chilamkurthi Sultan M Salim A Rahman A Element P Boyce Ct Finegan Na Salford Care Centres Weaste Buch Kh Singh Hs Warburton Salford Health Matters Ahuja A Browne Nb Mccorkindale S Collier Jeet I Lindsay Sd Yates Ms Tamkin Ej Sharma Mm Malcomson Ci Kassam Nn Singh H Haber S Khan Mt Dr Amin Kyaw T Hope B Dr Loomba Joshi V Marginson Je Dr Budden Randall Sc Tankel Jw Stedman Hgb Koria K Tyrrell Nm Allweis B Ghosh Pr Saxby K

Practice Name

Achievement 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00% 8.00% 9.00% 10.00% Prevalence % Exceptions % Not Achieved % Achieved % Actual prevalence Average Achievement

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Diabetes Mellitus 12 2008/09

% of patients with Diabetes in whom the last blood pressure was 145/85 or less 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Salim A Gore H Sultan M Drs Nagesh & Chilamkurthi Leach G Borg-Costanzi Jm Tauk T Davis Ws Larah Dg Dr Loomba Salford Care Centres Weaste Jeet I Haber S Levenson S Boyce Ct Dr Amin Collier Locum To Dr Chowdhury(Jeet II) Tankel Jw Tamkin Ej Salford Health Matters Joshi V Rolfe Jn Singh Hs Malcomson Ci Marginson Je Randall Sc Element P Browne Nb Rahman A Warburton Ghosh Pr Koria K Stedman Hgb Finegan Na Sharma Mm Kassam Nn Sinha Rp Singh H Buch Kh Saxby K Mccorkindale S Hope B Kyaw T Khan Mt Tyrrell Nm Ahuja A Allweis B Lindsay Sd Dr Budden Yates Ms

Practice Name

Achievement 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00% 8.00% 9.00% 10.00% Prevalence % Exceptions % Not Achieved % Achieved % Actual prevalence Average Achievement

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Salford PCT - Practice Points Achievement 2008/09

200 400 600 800 1000 L e a c h G L e v e n s

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S S i n h a R p D r A m i n B r

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n e N b D a v i s W s S u l t a n M R

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d H e a l t h M a t t e r s T a u k T E l e m e n t P J e e t I M a r g i n s

• n

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e B L a r a h D g W a r b u r t

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d C a r e C e n t r e s W e a s t e S t e d m a n H g b H a b e r S S i n g h H s B u d d e n S h a r m a M m K a s s a m N n D r L

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d h u r y L i n d s a y S d A h u j a A R a h m a n A T y r r e l l N m M c c

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k i n d a l e S D r s N a g e s h & C h i l a m k u r t h i G h

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h P r K y a w T S i n g h H

Practice Name Total Points

PATIENT EXPERIENCE PATIENT EXPERIENCE ADDITIONAL SERVICES ADDITIONAL SERVICES ORGANISATIONAL CLINICAL

All single GP practices

22 Anti-Coagulation Services Drugs Active Case Management Near Patient Testing Access/Extended Hours Heart Failure Services Homeless Services Minor Surgery Osteoporosis Cardio-Vascular Disease Smoking intrauterine contraceptive device (IUCD) Insertion IM&T Learning Disabilities HPV Vaccination Childhood Vaccination & Immunisations Safe Haven Service Influenza & Pneumococcal Immunisations Alcohol Tier 1 (DES) Alcohol Tier 2 (LES) Gateway Programme Ethnicity Health Inequalities Practice Based Commissioning Choice & Booking

Enhanced Services

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Other Contractual Arrangements

• Personal Medical Services Contracts

(PMS)

– Locally negotiated – Based on GMS Contract

• Equitable Access

– Tendered Contract, open to competition – 3 – 5 year contracts

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The GMS Contract – Key Points To Reflect On

• Based on need
• Clinical good practice incentives
• Flexibility in the way it can be delivered
• Encourages larger group practices
• Local tailoring via LESs

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• Contract in perpetuity
• Clinical quality must be a process of

continuous improvement

• Negotiated with a powerful body
• Doctors as practice mgrs with salarieds
• The single hander “problem”
• Limited use of flexibilities

The GMS Contract – Key Points To Reflect On

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Suggested Areas of Improvement

• Targets should be more and more challenging
• Percentage of income within QoF should

increase

• Patient choice should be encouraged
• Good practice / innovation in contract use should

be encouraged