The Polyclinic Service Model Dr Miguel Godfrey HUDU: Can Planning Deliver? Planning for Health and Social Infrastructure 14 May 2008
Change Is On The Way Sainsbury Doctor set up shop Guardian, 7 March Super-surgeries to go on trial in first steps towards Tesco-style franchises Times, 17 December 2007 Supermarkets to offer in-store GP BBC News, 25 February 2008 It s doc around the shop at Manchester store HSJ, 06 March
Governance structure for Healthcare for London Governance for HfL Consultation Joint Overview and Scrutiny Committee Joint Committee of PCTs All London PCT Boards NHS London Board Patient and Public Advisory Group London Commissioning Group Clinical Advisory Group Accountable Reporting Advising Scrutinising HfL Programme Executive Group HfL Public Consultation Next Stage Review Clinical Working Groups Mental Health Services Stroke Healthcare for London Projects Major Trauma Polyclinics Children s Services Local Hospital Feasibility Unscheduled care Long term conditions (Diabetes)
Polyclinic? Ignore the doctors polyclinics are the future Polyclinics mean different things to different people - Public Finance and Accounting Boris at odds with Ken over plan for NHS polyclinic Last chance to save your GP
The Polyclinic Project Heather O Meara SRO, CEO Redbridge PCT Tom Coffey Clinical Director, GP Wandsworth PCT Deborah Colvin Clinical Lead, GP City & Hackney PCT Marilyn Plant Clinical Lead, GP Richmond & Twickenham PCT Christina Craig Project Manager, Healthcare for London Project Team Jennie Bostock (Senior Project Officer), Sophie Coronini-Cronberg (Project Officer) Vanessa Leyton (Project Administrator), and Miguel Godfrey (Project Policy Manager)
The Polyclinic Service Model A Framework for Action set the need to develop a new model of community based care at a level that falls between the current GP practice and the traditional District General Hospital. It sets out: the services that could be provided the hours the services could be available the different types of organisational model to be clear that the concept is flexible and the design and localities of each polyclinic would need to meet the needs of each community
Principles of the Polyclinic Service Model Meeting individual needs and improving choice this means giving patients control of how, when and where their health and social needs are met. Regionalising services where necessary - this is about bringing services closer to the patient wherever possible s and giving them access to excellent specialist care. Integrating care and partnership working - this means making healthcare and social care joined-up to promote the individual s general wellbeing. Prevention is better than cure actively promoting individuals physical and mental wellbeing and helping them to stay healthy. Equality of health healthcare accessibility this is about giving everybody access to the best possible health and social care but particularly helping those facing the most inequality of care.
Polyclinic Service Model A polyclinic development programme is to gather information and explore issues on how the polyclinic services model could work encourage very wide range of pilots pilot for three months co-develop with PCT the local interpretation of polyclinic A polyclinic development programme is not predetermined it will be shaped by consultation a building there is no one size fits all solution to a commissioned service model PCT commissioners commit to exploring the range of services in a polyclinic Polyclinic the organizational models and locations commissioning within the competition framework the enablers: Workforce, IT and transport etc.
Setting out the services GP: o GP Services - Consulting and procedure rooms - Dedicated child-friendly facilities - Core and extended GP services - Extended hours 8AM-8PM o Practice Nurse services Community Services: o District Nursing o Health visitors & children s services o Midwifery o Specialised therapies o Outreach services (TB/HIV) o End-of-life care o Dieticians o Available 12 hours Pharmacy o Medicines use review o Medicines management services o Anti-coagulation services o Dispensing services o Available 18 24 hours Other Healthcare Professionals: o Optician o Dentist o Other health professional o Available 12 hours Interactive Health Information Services: o Smoking cessation o Drug and alcohol information services o Weight management o Sexual health o Dietary services o Local services (e.g. social services, back to work services, and leisure facilities) o Healthy living classes o Available 18 24 hours Minor procedures: o Phlebotomy o IUCD o Suture removal o Joint injections o Minor surgical procedures o Joint injections o Available 12 hours Outpatient Services: o Management of chronic illness (e.g. COPD, asthma and diabetes) o Community paediatrics o Consultant or PwS o Mental health o Audiology o Chemotherapy o IV transfusions o Access to pain management o Available 12 hours Urgent Care: o Minor injuries unit o Walk-in centre o Urgent care centre o Available out of hours Diagnostics: o ECG, Pulse Oximetry, Spirometry o X-ray, U/S and Vascular Doppler o CTG o CT, MRI o Colonoscopy o Haematology, microbiology and pathology o Available 18 24 hours Long Term Conditions: o Detection of undiagnosed o Screening & early detection o Community matrons o Management of disease registers o Access to - Expert patient programme - Information prescriptions - Managers of complex needs oavailable 12 hours
Organisational Models DIFFERENT TYPES OF POLYCLINIC A NETWORKED POLYCLINIC SAME-SITE POLYCLINIC HOSPITAL POLYCLINIC Existing GP practices would link to a local hub for specialist clinics and services such as blood tests, scanning and plaster facilities. The hub could be developed from an existing GP practice or other provider or a new building GP practices could come together under one roof, sharing many services but being run as different practices, perhaps linking with some other practices GPs could merge into one large practice, again linking with other practices which are not on the same site. Based at the `front door of local hospitals. These would be led by GPs and other healthcare professionals experienced in working in the community and they would provide the local population with the same range of services and staff as other polyclinics but be open 24/7.
Development Workshops Polyclinic Development Programme Workshops Workshop 1 Workshop 2 Workshop 3 Workshop 4 Workshop 5 Introduction and Services The Key Enablers Organisational Models Commissioning Key Learning & Next Steps 1 st May 21 st May w/c 9 th June w/c 23 rd June w/c 7 th July Introduction The Service Model Services Case studies Integrated patient care Identify Enablers IT requirements Workforce requirements Training (needs & facilities) Modelling access Organisational models Location models Advantages disadvantages Governance arrangements Enablers and constraints Options (pros & Cons) Case studies Key Enablers Skills & Expertise Consolidate key learning Outstanding issues
Transport Facts & Figures Nearly 1 million trips/day are made in London to or from health services This equates to almost 5% of all trips (as compared with, for example, 13% of all trips being for education and 19.5% for shopping) 51% of trips are made by car as driver or passenger 19% are walking trips, 14% are made by bus, 10% by tube and rail There are around 1,600 GP practices in London The average travel time to the nearest GP surgery for Londoners is around 8 minutes. For more than 80% of Londoners, the quickest way to access the nearest GP surgery is by walking These figures emphasise the importance of local access by foot to health facilities and the important role of the car, and to a lesser degree public transport, in longer journeys.
CAPITAL
Public Transport Accessibility Index (PTAI / PTAL)
Spatial and other key data sets (e.g. census) Travel network data (Public transport, highway information, etc.) CAPITAL HfL COMMISSIONED SERVICE TRAVEL MODEL Master Model Desktop Model Health user data from NHS (service uses, demographic, etc) MODEL OUTPUTS Travel and other demographic impacts
Outputs of interest to the selection of pilot sites: intelligence on who would be disadvantaged by a choice of polyclinic location; intelligence on who would benefit from a choice of polyclinic location; effect of polyclinic site on changes in the average travel time for patients; effect of relocating primary (and some secondary) healthcare into a polyclinic on population dynamics e.g. distribution of those with a greater or less than a cut-off percentage change in average travel time, identification of disproportionate negative impact in disadvantaged areas; effect of GP relocation to a polyclinic on average travel times; effect of opening a polyclinic on public transport accessibility (based on current usage and availability). Allow for information to be updated at regular intervals
End Questions?