Corporate slide master Prudent With guidelines Healthcare for corporate presentations in Wales Frank Atherton Chief Medical Officer October 2017
communication CITIZENS National Assembly for Wales Welsh Government Cabinet Secretary for Health, Wellbeing & Sport NHS Executive Board Health and Social Services Group (WG) Health Boards Welsh Ambulance Trust Permanent Secretary (WG) NHS Trusts Velindre NHS Trust Public Health Wales NHS Trust Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff & Vale Cwm Taf Hywel Dda Powys Local Communities/Stakeholders
Why think prudent? 3 million people in Wales 18 million primary care appointments / year 1 million OP referrals / year 400,000 emergency admissions / year 26 prescriptions / head / year 80 million blood tests (40% duplicates or ignored) Overall 10-30% contribution to health outcome www.prudenthealthcare.wales
Evolution of Prudent Healthcare Autumn 2013 Bevan Commission paper January 2014 Minister s keynote address to Welsh NHS Confederation Conference Spring 2014 - Applied workshops ENT, Orthopaedics, Pain and Prescribing January 2015 finalised principles July 2015 - international prudent healthcare summit. National action plan idea floated. December 2015 Team Wales Event. www.gofaliechyddarbodus.cymru www.prudenthealthcare.wales
The guiding principles of prudent healthcare www.gofaliechyddarbodus.cymru www.prudenthealthcare.wales
Implicit paradigm shifts Specialist Complex Quantitative RCT Bench to Bedside Consultation Patient Diagnosis Effectiveness Medical Generalist Simple Qualitative Real world Home Service Person Symptom Experience Social
International Movement
Peer groups Education Innovation Finance Academy Finance Delivery Unit Atlas of Variation PROMS & PREMS ICHOM 1000 Lives Quality Improvement Value Based Care Prudent Healthcare Choosing Wisely Wales Quality and Value Initiatives in NHS Wales
Reallocating resource for Value across a programme of care (COPD) Inhaler Therapy Smoking & Flu PR HIGH low Inhaler Therapy Pulmonary Rehab Smoking & Flu Actual Spend Cost per QALY @ Copyright Value Based Health Care Team; Aneurin Bevan University Health Board
PrescriberBasicPrice 4600000 Respiratory Prescribing Cost Trend (WP10 & WP10HP) 4500000 4400000 4300000 GP/ Nurse education events 4200000 4100000 4000000 3900000 3800000 Asthma Adult Guidance Seretide evohaler to Flutiform started COPD pathway 3700000 3600000 3500000 Mar-14 Jun-14 Sep-14 Dec-14 Mar-15 Jun-15 Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Dec-16 Mar-17 Period Courtesy of Jackie Reynolds
Reallocating resource for Value across a programme of care (COPD) : Finance Prescribing savings 1 million per annum Estimated 449k per annum saving through decreased healthcare utilisation (Griffith et al, Thorax 2001) Investment required for gold standard pulmonary rehabilitation service 241k per annum @ Copyright Value Based Health Care Team; Aneurin Bevan University Health Board
Antibiotic prescribing by dentists in Wales Individualised prescription forms for dentists In 2015, only 1.8% dental prescriptions were unidentifiable Antimicrobial audit Newsletter for GDPs outlining audit findings Waiting Room poster for patients BDJ article VOLUME 221 NO. 1 JULY 8 2016 Antimicrobial prescribing by dentists in Wales, UK: findings of the first cycle of a clinical audit www.gofaliechyddarbodus.cymru www.prudenthealthcare.wales
www.gofaliechyddarbodus.cymru www.prudenthealthcare.wales
Items of antibiotics Items of Antibiotics Prescribed 2010-2015 250,000 200,000 237,880 233,191 223,918 208,598 198,258 185,370 150,000 100,000 50,000 22% decrease between 2010 2015 In 2015, 7% of all antibiotics prescribed in Primary care were dental 00 2010 2011 2012 2013 2014 2015 Year Anup Karki, Consultant DPH, PHW : Antibiotic Prescribing in Primary Dental Care
Next Steps Strengthen national oversight/leadership Catalogue of successful initiatives Methodology for scaling National awards Integrate with Quality Improvement Incorporate into learning/development programs? public engagement