Professor (Hon)Vijay Kumar FRCS(Edin) MRCGP. Chair-Royal College of General Practitioners Yorkshire. President Association of Surgeons in Primary care

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1 Professor (Hon)Vijay Kumar FRCS(Edin) MRCGP Chair-Royal College of General Practitioners Yorkshire President Association of Surgeons in Primary care Member National council of Presidents-Association of Surgeons of Great Britain & Ireland Commissioning lead-royal College of General Practitioners- Yorkshire

2 THE NEW FIT Department of Health NHS England CCG Health and Wellbeing Boards Local Healthwatches Public Health England Local Authorities Providers FTs regulated and licensed by Monitor (economic) and all providers regulated by CQC (care quality)

3 WHY THE CHANGES?

4 THE CURRENT STRUCTURE-Separate workings

5 The Government s aims for the Health and Social Care Act A stronger voice for patients: Patient-centred care No decision about me without me Creation of Healthwatch England within the CQC and Local Healthwatch organisations to represent the voice of service users Focus on patient outcomes rather than processes Extend choice and competition Overhaul of the commissioning structure Increase autonomy of providers with all NHS trusts becoming foundation trusts (FTs) New approach to provider regulation creation of a licence issued by Monitor Savings of 15 Billion over 3 years (?)

6 Perception of a doctors surgery? copyright-avk-rcgp

7 WRONG! OUR CURRENT PRIMARY CARE CENTRES

8 Surgical/orthopaedic/Opthalmology/Urology/diagnostics/ & Dermatology/other Speciality community centres copyright-avk-rcgp

9 GP SURGERY/Community surgical unit 2014-NW Newton abbott hospital GP Surgery/Community surgical unit 2009 yorkshire

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13 Various Endoscopies in the community health centres Ultra Sound guided invasive procedures

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15 Level 1 these services can be provided by Gp s with basic surgical skills in a basic minor op /treatment room: 1. Sebaceous cyst, 1. Lipoma less than 2cm, 2. In-growing toe nail; 3. Excision of small lumps and bumps 4. Chalazion 5. Injection of Joints and Bursae 6. Cryotherapy 7. Aspiration of cyst And those mentioned in the New GMS contract(2004) Level 2- These can be delivered by Consultants / GPwSI/ PsI with enhanced Surgical experience from a modified Treatment room/operating theatre: 1. Vasectomy 2. Carpal tunnel decompression 3. Ganglion of the wrist(dorsum) 4. Zadeks for IGTN 5. Ligation of varicose veins 6. Haemorrhoids injection 7. sigmoidoscopy 8. Gastroscopy 9. Cystoscopy 10. Caudal Blocks

16 These services can only be performed by qualified and trained surgeons in a primary care setting from a fully functional operating theatre: 1. Inguinal hernia 2. Repair femoral hernia 3. Repair epigastric hernia 4. Umblical hernia repair 5. Large lipoma s 6. Circumcision 7. Frenuloplasty of the penis 8. Re Do CTD 9. Colonoscopy 10. Reversal vasectomy 11. Highlight Ligation and stripping of varicose veins Other examples can be delivered from a Primary care setting include: 1. Ophthalmology:Phako cataract surgery,lid surgery, 2. Dermatology- Scc Procedures 3. Urology-Urodynamics 4. Plastic surgery-dupuytrens Fasiectomy 5. ENT laryngoscopy 6. Gynaecology-Colposcopy 7. Radiology diagnostic ultrasound,echo 8. Pain clinic

17 Advantages of shifting appropriate surgical procedures to a community setting include : 1. Easier access & free car parking facilities. 2. Familiar setting. 3. No struggle around time of operations. 4. Patient in surgery for a short period of time and performed under local anaesthetic. 5. One stop clinic in the majority of cases./no stay surgeries. 6. DNA (did not attend) percentage is a fraction as compared to hospitals. 7. Continual care at the practice./few problems arise. 8. Close care in regards to home rehabilitation. 9. If a follow up is required they can be seen by the same carer. 10. High satisfaction./ccg satisfied: low cost surgery. 11. Fully accountable service. /Improved integration between primary and secondary care. 12. High volumes of minor and intermediate and such trainees have excellent hands on access to training skills. 13. Frees up more space, so that patients who need hospital care, can be given with quicker access.

18 Early 2000 s to 2014-Traditional new model of care American HMO S considered as goods example for the NHS DH/PCT Trips out to Kaiser Permanante Oaklands North San Francisco Centre copyright-avk-rcgp

19 Blue Cross & Blue Shield of California-Sacremento Link With Doncaster since 2009

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21 Dalton review Models deployable at an enterprise, group of services or service level Locality based single or multi-site trust Federations (e.g. UCL Partners) Service level chain (e.g. Moorfields) Joint venture (e.g. GSTS Pathology; SWLEOC) Management/operational franchise (Circle at Hinchingbrooke was the main example ) Geographically dispersed multi-service chain (e.g. BMI) Vertically integrated care organisation (Tameside) copyright-avk-rcgp

22 VANGUARD SITES Bid For Interest in 2015 Multi-speciality Community Providers-INCLUDING SURGERY IN THE COMMUNITY Primary and acute care systems Urgent care Networks Viable smaller hospitals Specialised care Modern maternity services Enhanced healthcare in Nursing Homes 250Million of new money copyright-avk-rcgp

23 The Response 260 APPLIED AND 29 SELECTED Rest to be followed up with action plan Integrated Primary and Acute Care Systems joining up GP, hospital, community and mental health services 1. Wirral University Teaching Hospital NHS Foundation Trust 2. Mansfield and Ashfield and Newark and Sherwood CCGs 3. Yeovil Hospital 4. Northumbria Healthcare NHS Trust 5. Salford Together 6. Lancashire North 7. Hampshire and Farnham CCG 8. Harrogate and Rural District CCG 9. Isle of Wight Multispecialty Community Providers moving specialist care out of hospitals into the community 10.Calderdale Health and Social Care Economy 11.Derbyshire Community Health Services NHS Foundation Trust 12.Fylde Coast Local Health Economy 13.Vitality 14.West Wakefield Health and Wellbeing Ltd 15.NHS Sunderland CCG and Sunderland City Council 16.NHS Dudley CCG 17.Whitstable Medical Practice 18.Stockport Together 19.Tower Hamlets Integrated Provider Partnership 20.Southern Hampshire 21.Primary Care Cheshire 22.Lakeside Surgeries 23.Principia Partners in Health copyright-avk-rcgp

24 OUR MANTRA! YOU WANT IT we will be getting it

25 WHERE DO WE STAND in England Specialist surgical procedures which are BEING delivered from a primary care setting: Ophthalmology incl cataracts(100%increase) Dermatology Urology ENT Gynaecology Radiology Gastroenterology Hernia;s Newer models OF AQP For : Vascular Surgery! Haemorrhoids rx Contracts for arthroscopy Joint working Procedures in Primary care-gp-consultants New Members on Board

26 Short wait times Average 2 weeks from GP referral to first appointment in your doctors surgery 1-2 weeks from consultation to surgery Surgical treatment our consultants operate in local centre with all the facilities you d expect & low infection rates Quality of care 99.8% of our patients rated our service good to excellent We achieved 100% of NHS quality targets (CQUINS)

27 Local to you Outpatient clinics in your local GP surgery, rehabilitation using local physiotherapy services Continuit y of care Patient liaison team From referral to consultation, diagnosis & treatment you ll see the same consultant at every stage of your journey You ll be given a named contact from our patient liaison team to help you manage your appointments and answer any questions you may have

28 THREATS Care Quality Commission-What are they looking for? CQC Stops Dr From Practising-April 2015 Revalidation- Patient complaints- Expectations- 14,000 GMC complaints a year-incl.on Line, NCAS issues. Premises-DDA/Liability Poor Recruitment Increased staff costs Lesser Re-embursement

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30 Thank You Questions? My Contact details- ASPC/ASGBI Direct- My Local PA The VIEWS EXPRESED HERIN ARE ONLY MINE AND NOT OF ANY ORGANISATION QUOTED ABOVE copyright-avk-rcgp