System Cost Reduction The vital role of Primary Care - PowerPoint Presentation

1. System Cost ReductionThe vital role of Primary Care Pan Islington GP ForumWednesday 16th January 2019

2. 2What we will be covering today…… What do we mean by system cost reduction? Why is it important?Examples of the successes we have achievedWhat are some of the current priorities that we need your help to deliverWhat is on the horizon in terms of potential new initiatives Breakout session (45 min) - topics for discussion:What has worked well?What could have been better and how can we improve?What are some of the practical actions we need to take going forward? Are there any burning ideas for service/pathway changes that you have for us?

3. Primary care investment can only be maintained if we reduce the overall costs of the system Situation: The NHS Long Term Plan reinforces what many of you already know – that a sustainable health and care system is underpinned by robust primary care services. We have to maintain sufficient levels of investment in primary care for this to be true.Complications: The key challenge that we face is that our spend on secondary care services is spiralling and this inhibits our ability to free up resources for primary care. This has been compounded by the fact that providers and commissioners have up until now worked in isolation to improve efficiency across the system through ‘QIPP’ and ‘CIP’ (Provider-led Cost Improvement Programme) initiatives. Many of these interventions have delivered significant cost benefits to sections of the system. However, the lack of coordination across commissioners and providers often results in these costs shifting from one part of the system to another and does not always achieve net cost reductions.Solution: Consequently, we must find a more collaborative approach to system cost reduction where we work hand in hand with secondary care colleagues. The North Central London system-wide ‘Medium Term Financial Strategy’ has outlined some of the principles that we need to adopt to make this a reality – the following are a few examples:We will focus on the benefit to the system, not on the impact to the individual organisationWe will ensure no individual organisation loses out for doing something in the benefit of the wider systemStrong clinical and operational engagement in everything we do

4. Clinical Advice and Guidance and MSK are two examples of successful system cost reduction MSK – Single Point of AccessFollowing the launch of the MSK Single Point of Access in July last year where referrals are triaged by a senior clinician before being booked onto the most appropriate service, Whittington Health NHS Trust and North Middlesex University Hospital NHS Trust have each seen a marked drop in activity. When compared to last year, the number of first and follow-up appointments in secondary care specialties like orthopaedics and rheumatology has fallen by 35% and 32% respectively. What this means in practice is that more patients are getting quicker access to the service that is right for their needs. Clinical Advice and GuidanceSince its launch the service - which allows a GP to seek advice from a hospital clinician - has evidenced the following metrics:195% increase in clinical queries (from 762 to 2250) made via this route between April-Nov 2019 compared to the same period in 2018. This can be a proxy measure for potentially avoidable referrals whereby it is assumed that c.30% of the queries would have otherwise resulted in a referral (based on best practice)So that’s roughly 675 fewer OP appointments!We’d like to thank everyone who has and continues to use the service. Through your support and collaboration with hospital clinicians we have been able to better manage patients’ care and improve the quality of referrals.With all major specialities currently available at the four main acute trusts in north central London, we’re continuing to work with providers to increase the offering to GPs and improve response rates and turn-around times.

5. Outpatient Transformation is a key priority for 2020 and we need your continued support to make it a success  Stage  Scheme/Idea  Details  Pre-Referral Manage in primary care High quality referrals to support streamlined secondary care managementReferral to most appropriate secondary care clinicianGP Helpline Access to Neurology consultant advice by phone same day to reduce referrals and admissions e.g. On the day advice avoid an on the day referral Clinical PathwaysGP Portal: Establish pathways and follow all steps to reduce inappropriate referrals Primary Care Education: Raise awareness of new pathways and their correct use Patient Education: regarding pathway changes to manage expectations Investigations and Blood Tests: ordered by primary care ahead of OP referral e.g. Blood tests, CXR, ECG, FITEnhancing referrals to community services MSK Single Point of Access: For T&O, Pain and Rheumatology Community Gynae: Pathways currently being reviewed for 2020/21Optometrist: First point of contact for Cataract, MECS and Glaucoma  Referral Management More efficient pathwayReferral to most appropriate sub specialty clinic first time.Reducing C2CReferral Assessment Service  Straight To Test: Nurse contact with patients prior to investigations eg colonoscopyIncomplete Referrals: Returned to GP for more informationVirtual review pathways to replace 1st OPAImage Review: By a consultant who decides on the next step in the patients pathway or returns care to GP with a comprehensive management planPost-ReferralReduction in Face to FaceShorter patient journeyRelease of system capacity Virtual review of imaging and bloods Patients are discharged without a face to face appointment is results are normalAlternatives to F2FPhone clinics, Video consultations and Group consultationsPatient initiated FUPAllocated patients can request a referral when their condition exacerbates. Discharge & Shared Care Principles for GP funding to be agreedShared Care ProtocolsUsually meds managements but increasingly for other conditions. Pre requisites:-Share care protocols articulating roles and responsibilities of patient, primary care and secondary care cliniciansPrimary care systems to identify patients requiring monitoring and track monitoring has taken placeRapid access to secondary care adviceRapid access clinics for patients who are deteriorating or results are abnormalPhone Check UpNurse or physio after an episode of careThe following are examples of the outpatient transformation initiatives that are currently being explored or expanded for 2020/21 – we will be in touch with further details:

6. Your early input into the development of future initiatives will maximise the chances of success Potential ideas to be exploredAmbulatory careExtended opening to 7 days per week for ambulatory clinics Furosemide lounge or primary care acute diuretic pathway to prevent admission Specialist nurses to ensure patients are on optimal management before discharge, even if admission was unrelated to the LTC, e.g. HF inpatients nurse for optimal meds to reduce risk of future admission and OPA.Reduce duplicate imaging or colonoscopies - in patientsVideo informationDiabetes structured education pre attendance Pulmonary rehab pre attendance Phone MDTSecondary care consultant for elderly and complex patients to agree most appropriate management. Consultation of GP and consultant to discuss cases Support to agree onward referral is not in the patient’s best interests and frame the conversation with the patient.CMC used in A&E to follow agreed MDT management plan

7. We are keen to get your feedback to ensure future developments are driven by expertise from the front line What has worked well?What could have been better and how can we improve?What are some of the practical actions we need to take going forward? Are there any burning ideas for service/pathway changes that you have for us?