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

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NICKY BROOKSDEVELOPMENT MANAGERPRACTITIONERS WITH SPECIALINTERESTS TEAM NatPaCT

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PwSIs and Impact Assessment

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

• Case studies

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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

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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

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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.

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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

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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

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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

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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

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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%

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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%

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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’

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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

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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?

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The Impact Assessment Tool

• Options to considerProvides references to existing websites with

resources and some specific tools already tried and tested

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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?

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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?

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CONTACT DETAILS:07766 020 [email protected]