IT Driving Efficiency or Efficiency Driving IT?
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- Aubrey Nicholson
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1 IT Driving Efficiency or Efficiency Driving IT? Dr. Naresh Rati CEO, Modality Partnership Mr. Paul Kemp Head of IT, Modality Partnership
2 Case for Change The current health and social care economy is facing unprecedented levels of pressure and will not be sustainable in the long term without transformational intervention Demographic Pressures and Increasing Demand Poor Access to GP Services Unsustainable System Strains Variations in Quality and Performance
3 Stages of GP Business Maturity Maturity Extended Primary Care Outpatients and other Services MCP Population Health Care Primary Care at Scale: Achieve resilience and economies of scale sharing functions/staff, IT to leverage efficiency Extended Primary Care: Scale allows diversification by bidding for opportunities and developing outpatients and other service offerings Population Health Management MCP/ACS opportunities by working closely with commissioners to design outcome-based contracts and implement MCP contracts Primary Care at Scale Transformation Management, Digitalisation and Empowerment Transformation Management, Digitalisation and Empowerment Management support to design and run programmes to enable sustainable change Timeline 3
4 Business Forms: Just a Means to an End Scatter Collaboration Full Merger Traditional Practice Model Federations Super Partnerships (Sole trader, multi-partners) 2k 15k patients 50k 500k patients 50k + patients
5 The First National GP Partnership in the NHS AWC 75k Hull 60k Walsall 29k Sandwell 26k Birmingham 85k Wokingham 28k 5
6 About Modality Partnership At a Glance Over 300K patients in six regions: Sandwell, Birmingham, Walsall, Berkshire, Airedale and Hull NHS Ethos / Single Partnership 1 and 2 care contracts Registered Population 320, , , , staff 38 primary care sites 100 Partners Executive Boards to oversee each region in a devolved model 120,000 70,000 20,
7 How our patients/consumers have changed. 82% of UK population using broadband to transact <1% of patients using the internet to interact with clinicians
8 Platform to underpin efficiency and performance Clinical Contact HUB Practice Level Back Office Support The Modality Platform Website Optimisation Patient Apps Re-routed NHS 111 Video consultations Twitter/Facebook Digital NHS F&F Test E consulting Care Navigation Call/Recall Standardised clinical templates Patient Interaction Initiatives Extended Access Enhanced Services Specialist Services Delivery Enhanced Primary care teams Physio/pharmacy/ANP/PA/EP MDTs with community HR Governance Finance /Payroll IT Support Group Purchasing Training SharePoint Change Management Lean Processes Continual Improvement
9 Access Channels 1. Patients contact the HUB by phone, or our website 2. The HUB verifies identity and books a same-day telephone or Skype consultation with their clinician, at their surgery 3. The clinician completes the phone or Skype consultation 4. If the patient needs to be seen face to face, the clinician invites them to the surgery that day.
10 Platform to underpin efficiency and performance Clinical Contact HUB The Modality Platform Website Optimisation Patient Apps Re-routed NHS 111 Video consultations Twitter/Facebook Digital NHS F&F Test E consulting Care Navigation Call/Recall Change Management Lean Processes Continual Improvement
11 The HUB: Clinical Contact Centre Staffed by up to 20 call handlers and online appointment mangers Up to 1,300 calls answered every day, serving over 46,000 patients Average call waiting time is less than 60 seconds Average call duration down to 2 minutes Trained Care Navigators to signpost to appropriate clinicians Demand for appointments has stabilised throughout the day, reducing the morning rush Patients call their surgery number
12 Digital and telephone access channels Clinical Contact Centre (CCC) alongside clinical transformation at sites Apps launched Health Coaching Modality plans for LTC
13 Who is using Skype? Patients with no phone, but access to a computer Patients that would rather see their GP/ANP face to face Patients that require an interpreter can complete a Skype consultation with a family member or friend, the same day Patients familiar with this technology; students and patients with family/friends oversees Patients with conditions that need to be looked at.
14 Social Media to interact with patients Patients are engaging with us on Twitter and Facebook. Where possible, we make contact with the patient to resolve any issues on What are we tweeting about? Family and Friends Test results Patient feedback Modality and practice news Health stories Walk-in clinic availability Early closures ModalityGP
15 Platform to underpin efficiency and performance Practice Level The Modality Platform Standardised clinical templates Patient Interaction Initiatives Extended Access Enhanced Services Specialist Services Delivery Enhanced Primary care teams Physio/pharmacy/ANP/PA/EP MDTs with community Change Management Lean Processes Continual Improvement
16 Clinical Performance Dashboard 16
17 Redesigning the Workforce Potential for Reallocation by Role For ANPs, practice managers, practice nurses and GPs, over 50% of tasks could be potentially reassigned to a lower cost resource ANP HCA Practice Manager Practice Nurse Receptionist GP Tasks by Role ANP HCA 30% of GP time spent on acute clinical conditions Practice Nurse GP
18 EPC and MDT Teams To do this we are: Creating Enhanced Primary Care teams, teams of care professionals who will have the responsibility of people within a practice register Creating Multidisciplinary Teams whose membership will include, amongst others, GPs, Practice Nurses, District Nurses, Social Worker, Mental Health Professionals who will have the responsibility for caring for people with complex needs and will cover a practice population of 10k-15k Shared Resource Making it easier for people to access an appointment and ensuring that they see the right professional at the right time. 18
19 Creating and Developing Clinical Roles New Role GP like role Assess, Diagnose, review, prescribe* (ANP only) LTC management ANP/PA Pharmacist Medication review Medication optimisation Review of minor ailments Reconcile medicines from discharge summary PDS/PCCF Scheme LTC Independent Prescriber* New Role New Role Assess, Diagnose & Treat patients with MSK problems Joint injections Refer for bloods/radiological tests Prescribe MSK Practitioner 19
20 Developing Existing Clinical & Non-Clinical Roles Upskilled Role Management of LTC (Diabetes, COPD, Asthma, Spirometry) Devolving tasks to HCA Delivery of routine care HCA LTC reviews i.e. Diabetic review B12 Bloods ECGs Devolving tasks to Admin/Reception Team Upskilled Role First point of contact Appointment booking Care Navigation New Patient Health Checks Fridge checks Stock ordering Re-Calls Practice Nurse Upskilled Role Receptionist 20
21 Broader Opportunities within SuperPartnerships Gynaecology Respiratory Urology ENT Healthy Communities Collaborative Sexual Health Older Adults Schemes Cardiology Rheumatology Specialist Services Intermediate care Mental Health Social Workers Education 3 rd Sector Health Villages Pilot Nishkam Partnership Dermatology Secondary Social Modality Foundation Trust Immunology District Nurses Orthopaedic GP care taking Teaching and Training GP practices Pharmacy Dentist Optometrist Primary Community District Nurses Health Visitors Physiotherapists Case Managers Intermediate care MSK Practitioners Osteopathy Substance Misuse Zero Tolerance X-Ray Research Podiatry Circumcision Clinic Pain Services
22 Platform to underpin efficiency and performance Back Office Support The Modality Platform HR Governance Finance /Payroll IT Support Group Purchasing Training SharePoint Change Management Lean Processes Continual Improvement
23 What is Modality SharePoint? The Modality SharePoint environment is designed to improve efficiency Easy access to core systems A single point of truth for essential organisation information Services designed to help you become more productive Moving towards a paperless environment
24 What does Modality SharePoint look like? Each core section is broken down into business area s such as HR, Compliance, IT, Practice information 24
25 What can Modality SharePoint do for me? Real-time feedback becomes an instant reality reducing the need for manual collection of data. Data is refreshed each time a form is submitted or a webpage reloaded 25
26 What can Modality SharePoint do for me? 26
27 What can Modality SharePoint do for me? You can now search for staff and obtain staff details without having to ask your colleagues. 27
28 What can Modality SharePoint do for me? SharePoint will automatically you if there is something it wants you to do such as follow up sick leave, Book an appraisal. You can allocate tasks to team members for items such as reading SOP s or completing simple tasks. 28
29 What can Modality SharePoint do for me? Important information is now at the click of a button such as the Managers Handbook. You can see when and who updated area s so you can be confident that your looking at the most up to date information available 29
30 Is it making a difference? New Model of Care: 70% of patients say that the new access system is better than before (based on >1,000 patient survey) 70% of patient needs can be addressed remotely without having to come into the practice Remote consultation time is significantly lower than F2F consultation (under 5 minutes on average) 72% reduction in DNAs (for us, this is equivalent to saving 2 WTE of GP appointments) Increased capacity and reduced pressure on GPs by changing skills mix (MSK - releasing 5.4 GP sessions per week; Pharmacist releasing 6.7 GP sessions per week) Consistently lower rate of utilisation relative to rest of CCG (Prescribing 8%, A&E 7%, Emergency Admissions 22%, Readmissions 25%) Outpatient Services: Significant improvement in patient wait times (Dermatology 80%, Rheumatology 74%, ENT 39%, Gynaecology 59%) GP Time Saved >18K appointments saved to date (approximately 1.9 WTE) System cost savings services are delivered at 25% (on average) lower than tariff paid to Secondary Care 30
31 Our Proposition: Focusing on What Really Matters We have designed the new care model through the lens of our population, patients, and workforce Population and Patients I know how to access care whenever I need it (24/7) I am always directed to see the most appropriate person I have access to the information I need to help me manage my own health and wellbeing I am always treated with respect and dignity I am supported to make choices about my health I am supported to stay at home for as long as possible if I am unwell Workforce I understand my role and responsibilities and how I am making a difference I am compensated fairly for my job I am well supported to succeed at my job I have access to training and development I am able to maintain a good work-life balance I have a clear view on how my career can progress 31
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