PRACTICE BASED COMMISSIONING
DEWSBURY DOCTORS CONSORTIUM COMMISSIONING PLAN 2008/09
Chairman: Rob Napier Chief Executive: Mike Potts
CONTENTS
1. INTRODUCTION 2. VISION 3. COMMISSIONING PRIORITIES 4. PATIENT AND PUBLIC INVOLVEMENT 5. BEST PRACTICE
Chairman: Rob Napier Chief Executive: Mike Potts
INTRODUCTION This document sets out the practice based commissioning intentions for Dewsbury Doctors Consortium (DDC) for 2008/9. This plan will demonstrate a commitment to improving the quality of care patients including managing patients in primary care through improved or extended services, ensuring the most appropriate use of secondary care.
The priorities identified by DDC follow national and Kirklees PCT priorities of: Achieving 18 week pathway Reduction in non-elective admissions National indicators from NHS Operating Framework – Vital Signs. Recommendations from Joint Service Needs Assessment DDC have identified the following priorities and areas for future development, from data analysis and local practice awareness of the community: •
Priorities for 08/09 – Review ophthalmology services Maternity care 24hr primary care diagnostics
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Future initiatives/development Alcohol abuse Obesity Mental health counselling
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Ongoing joint ventures across Kirklees Diabetes service redesign Phlebotomy Intermediate care and older peoples care
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Overarching all the above is development of: Patient and public involvement Performance monitoring
VISION By building and maintaining a partnership between practices, DDC will be able to develop and deliver high standard of care, closer to home, and which will meet the needs of our practice population.
Chairman: Rob Napier Chief Executive: Mike Potts
OVERVIEW The population of DDC consists of 3 GP practices: Slaithwaite Road practice – Dr Patel (Chair) Cherry Tree Practice – Dr Sood (Vice Chair) Albion Mount Surgery – Dr Thimmegowda With 13458 Patients in total. This will be the second year of working as a consortium, and this year will see : • • • • •
An appropriate level of organisational development for the Executive board, relating to PBC principles. Development of the Executive board in line with PBC, Understanding budgetary setting, Understanding the business case process and Performance monitoring.
This will initially be delivered by members of the PCT PBC team, with a view to further development work by external facilitators in the future. Members of the Consortium will sit on 2 HITs – Older people Children’s Further interest in Obesity HITs will be planned for the future. Linking with other GP’s, either through North Kirklees Consortium, or Stand Alones practices, for information from other HITs will help DDC keep up to date with developments, as well as information from PBC manager. As the practices within the consortium are widespread geographically, across 2 localities, community/locality development is difficult; however, all practices have similar demographics, and have a joint vision of working for the good of the individual practices, using a partnership approach to share ideas and expertise. Common themes from the JSNA have been captured within the priorities for plan, • Poor maternal health, in particular high incidences in both Batley and Dewsbury of Smoking and Alcohol consumption. • Babies dying within the first year of life, although Dewsbury has the higher incidence of twice the national rate, Batley is still of concern in this area. • Batley has the worse incidence of diabetes and strokes across Kirklees, alongside Dewsbury having high incidences of diabetes and hypertension, despite having a younger population overall. In response to this data, in line with 18 week agenda and reducing referrals and follow up’s to secondary care, DDC has agreed to concentrate on 2 main priorities for 08/09: Ophthalmology Maternity Care With a view for further developments in services to address 24hr primary care diagnostics Obesity and alcohol issues. Diabetes, Intermediate Care and Phlebotomy services are at present services which are under redesign, and DDC are committed to working with these work streams, to improve care for their patients.
Chairman: Rob Napier Chief Executive: Mike Potts
PRIORITY 1 Ophthalmology Reduce first and follow up appointments into secondary care Ophthalmology Services Aim To develop a jointly agreed pathway with secondary care providers regarding the management of patients with specific diagnosis. Provide a community ophthalmology service, available within the consortia, to address triage of referrals from optometrists prior to referral to secondary care to ascertain appropriateness. Provide a provision for follow up of specific ophthalmic conditions, following surgery. Current Position Majority of referrals into secondary care are generated from opticians via GP, who often refer without further consultation. All surgical follow up appointments are routinely seen in secondary care. Outline and Rationale of Proposed Service Practice based service to meet the needs of the practice community to provide a high quality service, which is identified by data verification and consultation with optometrists and secondary care providers. Both services provided by consultant, GPwSI, or other accredited practitioner. This service will address 18 week agenda, Reduction of secondary care activity, Bringing care closer to home JSNA for patients with visual impairment and LTC.
Actions and Timeline Data verification Evaluation of service to be provided Business care submitted
completed May 2008 June 2008 July 2008
Links/Barriers Potential lack of capacity in Primary Care and skill to manage patients in primary care. Reluctance of optometrists to work in partnership with primary care providers. Patient choice. Numbers within DDC too small to provide value for money.
Expected Outcomes All referrals will be appropriate for secondary care attention Majority of referrals will be able to be dealt with in practice via the practice based service All follow up’s of routine surgical procedures will be seen in primary care Identification of other conditions that can be better managed in primary care Increased capacity in secondary care to assist in achievement of 18 weeks target. Improved patient experience of ophthalmic services.
Chairman: Rob Napier Chief Executive: Mike Potts
PRIORITY 2 Maternity Care Aim Reduction in attendances to A & E of pregnant females for inappropriate treatments Reduction in attendances to secondary care for post natal care Current position High numbers of admissions to A & E and secondary care of mothers in the ante natal period, of which the majority are of short stay. High numbers of unexplained attendances to secondary care for post natal care, which could be delivered in the practice Outline and Rational of Service Work with midwives and health visitors to improve the understanding and so educate mothers in safe self care in pregnancy, when to access medical treatments, and the pathways to achieve the most appropriate care. Improve communications between mothers, practices and midwifery services to meet these needs. Improve access to the practice or midwife for mothers with concerns or problems, prior to accessing secondary care. Collaborate with secondary care to look at pathways which could improve the experience of mothers when problems occur in pregnancy. This service will address Reduction of secondary care activity, Bringing care closer to home JSNA to improve lifestyle of mothers in the antenatal period through education.
Actions and Timeline Data verification Collaboration with midwives/secondary care To identify appropriate service for DDC Business Case
May 2008 June 2008 July 2008
Links and Barriers Link with midwives and health visitor, Secondary care obstetric consultants Barriers Difficulty in identifying need to attend A & E due to insufficient data available to practices Increased capacity for community midwifery services. Patient choice Expected Outcome Reduction in attendances to secondary care, increased access to primary care service Improved education of mother in self care in pregnancy and post natal Improved communication between secondary care and practices in DDC Chairman: Rob Napier Chief Executive: Mike Potts
PRIORITY 3 The practices will undertake 24hr BP monitoring, ECG and Spirometry. AIM To enable patients to access diagnostics quickly, to ensure accurate diagnosis and treatment, only appropriate referrals into secondary care, and fitness for these referrals. Current position All patients are sent into Mid Yorks for initiation of 24hr blood pressure monitoring, 24 hr ECG and Spirometry. Results are returned to the practice at a later date Outline and Rational of Service The service will operate in all 3 practices, with trained staff undertaking 24 hr BP, 24 hr ECG and Spirometry. This will include education, application of equipment and care of equipment. Assessment of the results will be determined by the level of skills of the practitioners. The service will enable patients to have continuity of care closer to home, be in a less stressful environment, be seen by practitioners known to them and reduce referrals into secondary care diagnostics, whilst ensuring only appropriate patients are referred into secondary care, thereby, potentially reducing first appointments. Actions and Timelines Data verification Business case submission Commencement of service
May 2008 June 2008 September 2008
Barriers Lack of Staff Training Unable to assess results Over Capacity Priorities for future development The following areas of potential service redesign are intended for ongoing development, particularly for the end of 08/09, with further development in 09/10 Alcohol abuse Obesity Mental health counselling Ongoing joint ventures across Kirklees At DDC we are committed to supporting and collaborating with ongoing ventures for service redesign in the following areas: Diabetes Phlebotomy, if acceptable to North Kirklees Consortium Intermediate and older peoples care Children’s and Families Services
Chairman: Rob Napier Chief Executive: Mike Potts
Patient and Public Involvement Patient and public involvement in decision making around services and service redesign is recognised by DDC as a high priority. DDC will work with the PCT and other recognised agencies to ensure we are working in partnership to support the development of patient and public involvement. It is anticipated that regular meetings with the PCT will occur, to ensure robust processes are in place to engage patients and the public in the ongoing planning of services. Brief overviews of our plans are: •
Ensure patients and the public understand what practiced based commissioning is and provide information about decisions that have been made, in involve them in future decision making processes.
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Identify how patients and the public can be actively involved in the evaluation of service changes, and use this information to help shape future services.
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Develop strategies and practical approaches that enable patients and the public to offer their views about health services and participate in the development of services for 08/09.
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The translation of information into appropriate languages for patients and public for who English is not their first language, and also address other language impairments, which could be seen as a barrier for patient and public involvement.
It is recognised we will have to work with the PCT and other agencies to achieve these aims. Best Practice DDC will participate in Trust wide discussions to ensure that the successes and failures of theirs and other consortia are understood, and use this as a learning process. This will ensure best practice and successful projects are shared and adopted. DDC will adopt pathways developed by other consortia or stand alone practices, where they have been proven to have a beneficial effect on services to patients and providing these benefits are transferable to local needs of DDC.
Chairman: Rob Napier Chief Executive: Mike Potts
I confirm that this plan is an accurate representation of the practice’s intentions for PBC for 2008/09.
Signed
Name
Date
Chairman: Rob Napier Chief Executive: Mike Potts