1 NICKY BROOKS DEVELOPMENT MANAGER PRACTITIONERS WITH SPECIAL INTERESTS TEAM NatPaCT.

1

NICKY BROOKSDEVELOPMENT MANAGERPRACTITIONERS WITH SPECIALINTERESTS TEAM NatPaCT

2

PwSIs and Impact Assessment

• Background• National Impact Assessment • The Impact Assessment Tool for Local Work

• Case studies

3

Background

• Experience of meeting PCT staff across England

• Issues around choosing the most appropriate measure

• Issues around baseline measures• Need for a tool with a menu of options for

local services

4

National Impact Assessment

• MA Action on Programme (October 2002) • www.york.ac.uk/inst/yhec • Compilation of 6 GPwSI pilot sites• Consistent objectives – increase access, reduce

waits, streamline patient journey, develop / spread best practice and link 1 / 2 care

• GPwSIs dealt with range of conditions • At time of the evaluation 5/6 of the services been

established 9 months or less http://www.york.ac.uk/inst/yhec

5

National Impact Assessment• Process related findings• Activity analysis 30-40% referrals 2 care could be managed by

GPwSI70-80% patients discharged back to GPReduced follow up ratio in 1 care15-20% patients ref. consultant opinion or direct

onto WLLow DNA rates 1-2%Capacity 1 clinic per week 9-10 patients (p.a.

420-500 / 320-400 new patientsSurgical GPwSI 4 adult tonsillectomies per week

150-180 p.a.

6

National Impact Assessment

• Weekly clinic without audiological support Workload for 75,000 approx

• With audiological support 120-150,000• Patient satisfaction surveys unanimous praise• ENT consultants largely positive, • GPwSIs enjoyed challenges

7

National Impact Assessment

• GPwSI Orthopaedic Services University of Leicester (May 2003)

• www.le.ac.uk/cgrdu/pcd.html /pcd.html• Involved 3 city centre PCGs• RCT to test GPwSI in 1 / 2 care• Treating back and knee problems• Service objectives – to improve patient

management, reduce inappropriate referrals, and deliver good health status and patient satisfaction

8

National Impact Assessment• Little difference between two methods of

delivery• Initial waits GPwSI 7 weeks Consultant 17 weeks,

increased to 13 weeks and 19 weeks• 70% patients discharged back to GP after 1

appointment• 9% seen 3 times or more• Main interventions: advice, prescription, X- ray,

manipulation, injection• 5% referred onto Consultant• QOL first 3 months improved• Patient satisfaction largely positive (15 / 263

patients had negative comments

9

National Impact Assessment

• GPs in PCG 80% return – 82% had referred into service

• More than 80% happy with outcomes• Consultants 100% return - 50% had seen

patients from GPwSI clinic• 7 agreed with treatment given• GPwSI referrals to ENT Consultant 6/10 mostly

appropriate

10

National Impact Assessment

• Specialist PwSI Clinics Kings Fund (December 2004)

• www.sdo.ishtm.ac.ukw.sod.isthmus.ac.auk• Service objectives – access, patient / clinician

satisfaction, costs to the patient and the NHS• Final report not yet available – interim report• Waits / case mixMean wait 38 daysDNAs 7.4%Cancellations 2%

11

National Impact Assessment• Outcomes37% PwSI follow up22% discharged8% sent back to GP6% referred to hospital1% awaiting test results1% sent elsewhere23% data missing

• Reasons for referralAdvice on clinical management 68%Having a procedure 47%

12

National Impact AssessmentSeeking a diagnosis 30%Second opinion 23%• ½ GP using services reported quicker waiting

times• 1/3 GPs using the services reported lack of

clarity of referral guidelines • Wide variations in accrediting GPwSIs, training,

CPD• Lack of clarity about where responsibility lay• Costs and value for money difficult to establish

due to ‘free goods’

13

National Impact Assessment• Primary Care Dermatology Service, University of

Bristol (April 2005)h www.sdo.ishtm.ac.ukw. • Effectiveness, cost effectiveness, accessibility

and acceptability • RCT comparing care with usual hospital care • Triage in acute care with Consultant and GPwSI• Measures disease specific and global QOL,

patient views on accessibility, DNA rates and waiting times

• Process measures – what happens to patients once referred

• Economic analysis – including costs from a societal perspective – NHS and patients

14

The Impact Assessment Tool• Two main aspects1. Areas to consider when designing PwSI services2. Options for evaluating the impact of PwSI services• Areas to consider when designing PwSI services:Objectives of a PwSI service

Is the service able to provide comparable care?Does the service offer value for money?Is the service providing patient-centred care?What is the impact of the service on staff working in 1/ 2

care?

15

The Impact Assessment Tool

• Options to considerProvides references to existing websites with

resources and some specific tools already tried and tested

16

Case Study One

• COPD PwSI ServiceService outline:GPwSI 2 sessions per week (1 clinic, I

developmental / educational) NwSI 6 sessions per week (1 clinic, 5

developmental / educational)

What would be your short, medium, long term objectives and impact assessment measures?

17

Case Study Two

• Heart Failure PwSI ServiceService outline:GPwSI 1 session per week (one stop clinic) Pharmacist 1 session per week (one stop clinic)NwSI 10 sessions per week (1 clinic, 9

developmental / patient review/ care) What would be your short, medium, long term

objectives and impact assessment measures?

18

CONTACT DETAILS:07766 020 468NICKY.BROOKS@DH.GSI.GOV.UK