Commissioning Urgent Care: what do we know now and what does this mean for the new pathfinder consortia? Rick Stern NHS Alliance Lead for Urgent Care Director, Primary Care Foundation, [email protected]07709 746771 NHS Direct & NHS Alliance workshop 22 nd February, 2011 Central London
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Commissioning Urgent Care: what do we know now and what does this mean for the new pathfinder consortia? Rick Stern NHS Alliance Lead for Urgent Care Director,
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Commissioning Urgent Care:what do we know now and what does this mean for the new pathfinder consortia?
Rick Stern NHS Alliance Lead for Urgent CareDirector, Primary Care Foundation, [email protected] 07709 746771
NHS Direct & NHS Alliance workshop 22nd February, 2011 Central London
Developing the benchmark:rounds 1, 2, 3, & 4●First benchmark completed March 2009 with reports on 63 services and half-day workshops for commissioners & providers
●Second benchmark, with reports on over 90 services, completed November 2009,with first patient experience survey managed by our partners, CFEP UK Surveys
●Third benchmark reviewing performance at period of peak demand at Christmas 2009 and New Year 2010 –completed November 2010
●Fourth benchmark, again a full benchmark including patient experience with complete overhaul of questions to ensure full compliance with CQC report
The benchmark of out of hours services is comprehensive and provides considerable detail● Performance against all of the national quality
requirements● Clinical governance processes● Comparing advice, visits at a centre & visits at home● Urgent on receipt● Productivity● Additional measures of patients going towards hospital● Patient perceptions of your service● Case volume per 1,000 patients● Cost per case and cost per head
Learning from the first two rounds of the benchmarkImproving out of hours care: what lessons can be learned from a national benchmark of services? January 2010, PCF1. Out of hours services are improving 2. Patients value a responsive service3. Split services and double assessments seem to
perform less well4. Many providers are falling short on the standard for
definitive clinical assessment of urgent cases5. There is an enormous range across different
services in the proportion of cases that are identified as urgent
6. There is striking variation in cost, even amongst providers serving communities with similar population density
Red and Blue service are very different – red has very high advice and low home visits, blue has low advice and just above average home visits….% Advice
A new focus in the third benchmark: performance at times of peak demand
What can we learn from looking at performance and variation at Christmas 2009 and New Year 2010 when services face their highest levels of demand across 100 services in England?
Key Issues – reflections 1 “if everyone is involved it becomes seen as a joint baby, not a primary care service in their midst”
● Primary care practitioners and their complimentary skills offer an important way of improving services within A&E … but it is only one way, of many, for improving urgent care for patients.
● Good governance – or the way clinicians and organisations integrate care – is vital. The best services, have good systems for ensuring that consultants, GPs and nurses all work together.
● Best of both primary care and emergency medicine or clash of cultures? (varying approaches to training, managing risk, governance systems, language and their experience of different case mixes)
● Patients want to make choices about how and where to access health care, based on their own needs as well as their understanding of how easy it is to access the particular range of services in their area.
● Although primary care can potentially reduce pressure on Emergency Departments and improve patient care there is little evidence that it reduces Emergency Admissions or reduces overall costs to the NHS.
● There is also no evidence that public information campaigns – telling people not to go to A&E unless it is an emergency – change the way patients behave. What does make a difference is when patients consistently receive a rapid and effective service.
● Effective urgent healthcare systems have also begun to look at how financial and organisational incentives are aligned to promote the best possible care for patients (role of Urgent & Emergency Care Networks?)
● Important to remember other approaches for improving access to urgent care, especially improving the management of same day urgent care in the 8,200 practices across England.
Commissioning Urgent Care Key points to remember …1. GP commissioners are well placed to use their
clinical knowledge to drive improvements2. Look at in-hours general practice as the key to unlocking
improved performance3. Understand where there is good information and use it to drive
improvements in care4. Tackle unacceptable variation both between and within services5. Design individual services and the flow between services with a
good understanding of process and volumes6. A shift in culture to supporting clinicians who report problems is
as important as meeting standards7. develop a compelling local vision for 24/7 urgent care, with 111
as a lever for integrating care8. There is a cost to tendering – long term contracts may offer more
value
For more information please go to our new and improved website at www.primarycarefoundation.co.uk