Working with GPs to help deliver the NHS Health Checks Programme

Transcription

1 Working with GPs to help deliver the NHS Health Checks Programme Dr Matt Kearney GP Castlefields, Runcorn National Clinical Advisor Public Health England and NHS England

2 Why do we need GP engagement? 1. To encourage GPs to do more health checks 2. To ensure quality in health checks delivered by GPs 3. To ensure quality in follow up for health checks done elsewhere 2 Working with GPs to help deliver the NHS Health Checks programme

3 NHS Health Check Programme Key: Age Gender Ethnicity Risk assessment Family history Smoking status Alcohol use Physical activity Body Mass Index (BMI) Communication of risk Sign post or refer to life style interventions Risk Management NHS stop smoking services referral Alcohol brief advice or referral Exercise on prescription or other physical activity intervention BP: Blood Pressure HbA1c: Glycated Haemoglobin DM: Diabetes Mellitus egfr: estimated Glomerular Filtration Rate CKD: Chronic Kidney Disease RECALL Cholesterol test BP Measure Diabetes filter BMI BP Measure Dementia awareness and signposting If at risk HbA1c or Fasting Glucose Raised blood pressure If blood sugar high Risk Assessment Assessment for Diabetes^ High risk of diabetes D M If CVD risk assessed as >20% Weight management on referral Non-diabetic hyperglycaemia: Intensive lifestyle intervention Consider statin therapies* EXIT EXIT Diabetes High Risk annual register reviews All to be undertaken by GP Practice Team *or professionals with suitable patient information and prescribing rights ^People recalled to separate appointments for diagnosis Assessment for hypertension^ Serum Creatinine^ High egfr Low Anti-hypertensives prescription * CKD assessment Hypertensio n register CKD register EXIT EXIT

4 Economic modelling: annual benefits Prevention 1,600 heart attacks & strokes 650 cardiovascular deaths 4,000 new cases of diabetes Early detection 20,000 cases of diabetes or kidney disease 4 Working with GPs to help deliver the NHS Health Checks programme

5 Why do we need GP engagement? 1. To encourage GPs to do more health checks 2. To ensure quality in health checks delivered by GPs 3. To ensure high quality follow up for health checks done elsewhere 4. The NHS Health check will fail to deliver on its promise if we do not get GP engagement right 5 Working with GPs to help deliver the NHS Health Checks programme

6 New landscape Health checks commissioned by Local Authorities New Potential Improve access/uptake Improve consistency of health check delivery New Challenges Data flows Clinical acceptability of measurements and interventions Primary care response and follow up of abnormalities 6 Working with GPs to help deliver the NHS Health Checks programme

7 What can we learn about GP engagement from management theory? Dr Hilary Guite. Consultant Public Health Medicine. Healthcare Public health team. H&WB directorate. PHE. Jackie Davidson. Associate Director Integrated Prevention Programmes in Primary Care Royal Greenwich Local Authority

8 Change in a complex environment Understand the drivers for change in a complex system Understand general practices What do we know about GPs GP reasons for not engaging with NHS Healthchecks? Discuss the role of change agents introducing a complex innovation into a complex environment What makes for successful diffusion on an innovation Features of the innovation (NHS healthchecks programme); features of the adopting environment (the practice); change agent factors (local NHS healthcheck coordinators) 8

9 Drivers of change in complex systems 9 Burke and Letwin 1992

10 How many general practice systems are there in England? 1 NHS 211 CCGs 8230 GP practices [34,101 GPs,80% are principals] Each operates (currently) as a micro-system 10

11 What motivates people to be GPs? Data from GPs in the first 5 years of practice 1. Compatibility with family life 67% (63m 77f) 2. Challenging medically diverse discipline 65% 3. One to one care that GPs offer 42% 4. Holistic approach to patients 40% (30m 41f) 5. Autonomy and independence 25% (35m 18f).. 8. Good salary 10% (15m 8f) 11 Motivation and satisfaction in GP training: a UK cross-sectional survey. Watson J et al Br. J. Gen Pract 2011; DOI: /bjgp11X601352

12 GP reasons for not engaging with NHS healthchecks - all have legitimacy but some also cut into core motivations Concerns about the evidence base; safety of data transfer; AQP competence; generating a cohort of worried well patients; workload and remuneration (1. family life); Professional challenge of clinical work transferring to other professions and to other providers (3. one to one care) Diagnosing illness is more professionally satisfying than preventing it for many GPs (2. medically diverse and challenging) Historical resistance to be involved in public health practice (4 holistic approach to patients, not population group approach) Centrally mandated programme (5 autonomy and independence) 12

13 Change agent role introducing complex innovation to a complex environment Change agents are needed for complex innovations which require local leadership for implementation or where the adopting environment is heterogeneous A change agent is a bridge between the source of the innovation and the client. A change agent will match the innovation to the client s needs; give appropriate advice; information; training and support during implementation and maintenance NHS healthchecks requires whole system change within a practice to work optimally General practice in England is not one system but systems- need to understand motivation of each what attractors are there to the NHS healthcheck programme for each practice? Local NHS healthcheck teams are change agents 13

14 What factors encourage uptake of an innovation? 1. Features of the innovation Relative advantage (needs to be tailored to each practice s motivation and potential attractors to the programme) Compatibility (fits with existing values and needs renaming an innovation can help with this process, creating shared models of implementation etc Simplicity (the less training required the more likely adoption will take place) Trialability (try on a limited basis to begin with) Early results (make the results of the early adopters very visible- the diffusion will be quicker) 14

15 What factors encourage uptake of an innovation? 2. Features of the practice- spotting early adopters Cosmopolitan head (outward focussed) of the practice who has a high level of education (and continuing education) Opinion leaders convinced of the benefits of the innovation adoption for most people is based less on scientific evidence than on the advice of respected members of their social networks establish a guiding coalition early on An internal champion (someone in the practice who is prepared to stand up for the innovation and push for implementation) A formal decision making process to clarify if adoption will occur or not- non adoption is strongly associated with no formal decision making process 15

16 What factors encourage uptake of an innovation? 3. Features of the change agent Practice centred approach the NHS healthchecks programme should be matched to the practice s needs, attitudes, beliefs and norms Empathy- understand the practice s point of view and have close rapport Effort - high contact with the practices and persistence. Identify internal champions Credibility- have technical competence and the ability to stand up for NHS Healthchecks and communicate the likely benefits of the programme to each practice. Credibility is enhanced if the change agent is from a similar background (eg clinical, from local area etc). If this is absent empathy is vital! Leadership - have appropriate leadership skills both transformational (culture and paradigm) and transactional (mechanics of the innovation) Coalition building by gaining high level support in the area and a range of backers, including key opinion leaders from the local GP network, but do not force the pace 16

17 Working with GPs to help deliver the NHS Health Checks Programme Dr Matt Kearney GP Castlefields, Runcorn National Clinical Advisor Public Health England and NHS England

18 GP concerns Questions over the evidence base Influx of the worried well Increase in health inequalities We treat the sick Concerns over AQP competence and validity of health check Safety of data transfer and work load of data entry to clinical records Challenge of professional competition 18 Working with GPs to help deliver the NHS Health Checks programme

19 What can we do to maximise engagement Quality assure the health check o Competence, training, equipment, procedures Advertise the quality Support data flow in and out of practices o IG standards, automation, narrative etc. Local levers incentives, benchmarking, align with CCG priorities Evaluate Identify and champion examples of GP engagement Make the case 19 Working with GPs to help deliver the NHS Health Checks programme

20 Making the case for health checks Studies included in the Cochrane review bear little relation to systematic risk assessment and management of NHS Health Check GP questions are legitimate and are being addressed in design and delivery of the health check There is a pressing need to identify undiagnosed CVD risk and to tackle health inequalities Identifying and managing high CVD risk is likely to be effective and cost effective Despite our efforts in primary care, many people have undiagnosed risk and undiagnosed conditions and will have poorer outcomes as a consequence 20 Working with GPs to help deliver the NHS Health Checks programme

21 Engagement in Practice 21 Working with GPs to help deliver the NHS Health Checks programme

22 Engaging General Practice in the NHS Health Check Programme Bristol City Council February 27 th 2014 NHS Health Check Conference

23 Our journey so far... September practices signed up February practices signed up Total annual eligible population 100% of annual uptake -24,339, 50%- 12,169 30% in Q3 18 practices across the city with the highest deprivation outreaching to their local communities too!

24 1. Guiding Coalition- start up

25 2. Identify Synergies

26 3. Give Feedback

27 4. Communicate ( two way)

28 5. Engage early on to develop models in partnership

29 Engage early on to develop models in partnership continued.

30 6. Celebrate success

31 Areas we need to focus on next Increase uptake by practice Ensure we reach out to those who will benefit most Implement Quality Assurance Await evaluation of University of Bristol Study Further develop pathways to lifestyle services using the community asset based model and more equitable access to PH interventions

32 Thank you for listening