Blazing Trails in Calderdale Dr. Matt Walsh Dr Majid Azeb Dr. Graham Wardman Jake Abbas Sue Cannon Overview Our system is changing we will describe how and why. Our hypothesis is that we do not have sufficient grip on our management of urgent care. We know that the better management of Long Term Conditions will reduce demand for urgent care Our presentation will take you through how urgent care pathways operate at present, how we spend money to deliver care along these pathways and what we think needs to change. We want to explore with you how our system could work better through applying a different approach to Clinical leadership Patient involvement Developing a responsive and enabling management infrastructure 1
Halifax A Place of Contrasts 2
Improving Health, Improving Lives J o Commissioning Cycle O u r Monitoring Contracting Procurement Delivery Priority Programmes Strategy Strategic aims, parameters, guiding principles Stakeholder views Health needs assessment Business case: costs, benefits, risks Development Service redesign: infrastructure, CSI, clinical practice Service specification: key outcome, PIs 3
DO YOU RECOGNISE THIS? Primary care in England Strengths and challenges Strengths Challenges Millions of contacts with patients each year Services that don t always fit together & can be confusing to navigate Personal continuity of care & strong ties to local communities People want more involvement in their health and care Professional ethos and high levels of patient trust Unwarranted variability in quality and access to services Improvements in quality of care, e.g. for people with long term conditions Changing public expectations, demographics and nature of disease 4
Access to GP services 99% of public registered with a GP practice Average person visits a GP 4 times a year Over 15% of population see their GP in any 2 week period 85% of population generally satisfied with access to GP services: 90% 88% 86% 84% 82% 80% 78% 76% 74% 72% 70% Ability to book GP appointments in advance GP practice opening times Ability to get through easily on the phone Ability to see GP w ithin 48 hours Ability to see preferred GP The new NHS system Department of Health Public Health England (part of DH) NHS Commissioning Board NHS Monitor (economic regulator) Social care CQC (quality regulator) (Local health improvement in LAs) GP commissioning consortia Providers (in local authorities) Local authorities (via health & wellbeing boards) 5
NEW NHS SYSTEM PRIMARY CARE PHYSICIANS WILL CONTROL 80% OF NHS EXPENDITURE The urgent and emergency care pathway in Calderdale Multiple patient entry points GP Out of hours service Walk-in-Centres Ambulance service GP Practice A&E Hospital admissions Pharmacy NHS Direct 6
Out-of hours primary care challenge in Calderdale Know how to contact a GP OOH service [% Yes] Rating of care received from GPOOH service (% "Good") Awareness of GP Out of Hours (OOH) Services 2008/09, by PCT, Yorkshire 100% 90% 80% 70% England 60% 50% 40% 30% 20% 10% 0% North Yorkshire And York Doncaster East Riding Of Yorkshire North East Lincolnshire Care Trust Plus Sheffield Leeds Hull Teaching GP Patient Survey, 2008/09 Satisfaction of care received from GP Out of Hours (OOH) Services 2008/09, by PCT, Yorkshire 100% 90% 80% England 70% 60% 50% 40% 30% 20% 10% 0% Doncaster Hull Teaching North East Lincolnshire Care Trust Plus North Yorkshire And York Rotherham Leeds Wakefield District Barnsley Rotherham Sheffield North Lincolnshire Bradford & Airedale Barnsley North Lincolnshire Wakefield District East Riding Of Yorkshire Bradford & Airedale Kirklees Kirklees Calderdale GP Patient Survey, 2008/09 Calderdale Impression of speed of GP OOH care delivery [% It was about right] Ease of contacting GPOOH Service by telephone (% "Easy") Speed of care received from GP Out of Hours (OOH) Services 2008/09, by PCT, Yorkshire 100% 90% 80% England 70% 60% 50% 40% 30% 20% 10% 0% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Doncaster GP Patient Survey, 2008/09 Convenience of care received from GP Out of Hours (OOH) Services 2008/09, by PCT, Yorkshire Doncaster Hull Teaching North East Lincolnshire Care Trust Plus North Yorkshire And York Hull Teaching Wakefield District North Yorkshire And York North East Lincolnshire Care Trust Plus Leeds Leeds Barnsley East Riding Of Yorkshire Rotherham Rotherham Barnsley Sheffield East Riding Of Yorkshire Wakefield District Sheffield North Lincolnshire Bradford & Airedale Bradford & Airedale North Lincolnshire England Kirklees Kirklees Calderdale GP Patient Survey, 2008/09 Calderdale Reducing emergency admissions through effective primary care Association between smoking prevalence in people with LTCs and emergency admissions by GP Practice in Yorkshire and the Humber Age and sex standardised emergency admission rate per 1000 2007/08-2008/09 300 250 200 150 100 50 0 0% 10% 20% 30% 40% 50% 60% 70% 80% Smoking prevalence in people with a LTC 2008/09 Source: HES, NSTS populations and QOF Chart produced by YHPHO160 Strong relationship between emergency admissions across Y&H explained by smoking prevalence of those with long term conditions Emergency admissions for 19 Ambulatory Care Conditions: Q4 2008-09 140 120 National average performance is 95.00. All but 1 of PCTs in Yorkshire and Humber have a poorer performance than the average. 100 80 60 40 20 0 Nort h East Riding North East Yor kshi r e Lincs and York Leeds Kirklees Barnsley Calderdale North Lincs Bradford and Airedale Hull Doncaster Wakefield Rotherham Sheff ield Dist rict 7
The urgent and emergency care challenge in Calderdale Year on year 4.3% increase hospital cost 6.6% increase in hospital activity 12.5% increase in 0 days length of stay Total Hospital cost of 42 million (420million Kr) 12% of our total expenditure The urgent and emergency care challenge in Calderdale High and increasing em admissions, A&E activity, walkin centre visits High rate of NHSD calls and low proportion closed Low awareness of GP OOH, and poor patient satisfaction ratings Low spend on OOH GP quality overall OK but wide variations Readmissions quite high (incl. FnoF) 8
DO YOU RECOGNISE THESE ISSUES / CHALLENGES How do you : Manage demand in your system Improve the management of Long Term Conditions in primary care? Raise awareness of pathways? Move resources and capacity in the system? THE FUTURE URGENT & EMERGENCY CARE PATHWAY 9
Our conclusions Our system incentivises Activity Little success in changing patient behaviours for urgent care Management led change is not enough (Macro level) - Clinicians not properly engaged Opportunities System wide health and social care arrangements are changing Develop the capability of the microsystems to deliver improvement Develop Clinical Leadership Establish integrated metrics across the (macro to micro) system 10
Our question / Our offer How can we transform the urgent care system using microsystems across the primary / secondary and social care interface Partnership in our journey to develop and share the learning. Build on our history to deliver the long term vision for Calderdale 11