Community Integrated Healthcare – An Approach by Whitstable Medical Practice Transforming General Practice – Unlocking the Potential Nuffield Trust, London Wednesday 15 May 2013 Dr J M Ribchester Executive & Senior Partner, Whitstable Medical Practice
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Community Integrated Healthcare – An Approach by Whitstable Medical Practice Transforming General Practice – Unlocking the Potential Nuffield Trust, London.
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Community Integrated Healthcare – An Approach by Whitstable Medical Practice
Transforming General Practice – Unlocking the Potential
Nuffield Trust, LondonWednesday 15 May 2013
Dr J M RibchesterExecutive & Senior Partner, Whitstable Medical Practice
Whitstable Health Centre & Chestfield Medical Centre
OUR POPULATION’S HEALTH NEEDS Whitstable faces a growing health and social care challenge
associated with its ageing population. The population of over 65s in East Kent will increase by
41% between 2005 and 2020. Whitstable shows a greater proportion of over 65s in
comparison with the rest of the locality. The probability of having a Long Term Condition (LTC)
increases from 17%, for people under the age of 40, to 60% for those aged 65 and over.
People with LTC’s use disproportionately more primary and secondary care services, 52% of all GP appointments, 65% of all outpatient appointments and 72% of all inpatient bed days. This pattern will increase over time with an ageing population.
WMP ranked 182 out of 287 GP practices in Kent & Medway on the index of multiple deprivation
Long Term Conditions Registers
Disease Category Number % of Population
Hypertension 5052 15.14
Asthma 2105 6.31
Diabetes 1728 5.18
CHD 1323 3.96
COPD 579 1.74
Mental Health 208 0.62
Dementia 210 0.63
Heart Failure 313 0.94
Epilepsy 183 0.55
Obesity 2712 8.13
AF 680 2.04
Depression 3817 11.44
CKD 1172 3.51
Thyroid 1263 3.78
Stroke 669 2.00
WMP List Size Growth Since 1998
Whitstable Medical Practice List sizes 1.4.1998 - 1.4.2013
Screening Services:AAA National Screening Programme Centre 2009Guy’s Genetic Screening
2009Paula Carr Retinal Photography Service for Diabetes 2011
Day Surgery:Carpal Tunnel Surgery and Injection PathwayDermatological SurgeryLocal Steroid Injection ServiceUpper Endoscopy Service (hosted by WMP and provided
by Prime Diagnostics Ltd)Cataract Day Surgery Service (hosted by WMP and
provided by consultant ophthalmologists)
Therapists:Hearing Aid Clinic 2005Acupuncture
2006Chiropractic
2006Physiotherapy
2008
Long TermConditions
- Diabetes- Cardiology- COPD- Dementia
Urgent Care
- Practice based Level 3 Minor Injury Unit
- Fracture clinic- Co-located
ambulance response base
- co-located community pharmacy
Whitstable &TankertonHospital
EnhancedRehabilitation &Intermediate Care
Detailed
WISHWorkstreams
WISH Stakeholders
Workstream ALong TermConditions
Lead:Dr J RibchesterDr H Pinnock – COPDDr D Kanagasooriam
– Mental HealthDr R Pieters –
CardiologyDr R Brice – Diabetes
Supported by:KCHT, KFS, EKHUFT,
PUG,
Workstream BUrgent Care
Lead:Dr J RibchesterDawn Gaiger ENP
Supported by:KCHT, EKHUFT,
SECAmb,
Workstream CCommunity
ElectiveServices
Lead:Dr J Ribchester
Supported by:EKHUFT, PUG,
Workstream D
Whitstable & TankertonHospital – Enhanced
Rehabilitation &Intermediate Care
Lead:Dr J Ribchester
Supported:EKHUFT, Friends, PUG, KCHT,
KFS
University ofKent
WISH Board
South EastCoast
Ambulance(SECAmb)
East KentHospitalsUniversityFoundation
Trust (EKHUFT)
Friends ofWhitstableHospital &
Healthcare andPatient UserGroup (PUG)
WhitstableMedicalPractice(WMP)
18 GPs, 140 staff
KentCommunityHealth NHSTrust (EKHT)
Kent FamilyServices
(KFS)
Long Term Conditions – Interim FindingsDiabetesCost savings – 50% (delivery of Insulin
- Reduction in referrals- Less OPD follow-ups- More one-stop clinics- Positive patient experience
Further work: - identify comparator cohort- identify cost savings of all
services
Whitstable & Tankerton Hospital- Integrated Committee formed in 2010 to
explore funding options for an Integrated Health and Social Care Centre in Whitstable
- OBC prepared by WISH Manager with input from all stakeholders
- Work due to commence at C4G to consider future of all 3 Community Hospitals
IF THIS IS AN ACCEPTABLE NEW MODEL FOR URBAN GENERAL PRACTICES WHAT ARE THE OBSTACLES?
Practices combining to serve larger populations – perhaps 30,000-35,000
GP buildings that are fit for purpose New GP Management structures Buy-in from CCGs, NHS CB, RCGP, BMA etc New financial challenges Potential for upsetting local acute trust
and others.
AND THE PRIZES ARE ….. Benefits to patient care – more personal care,
closer to home, shorter waits Benefits to the health economy – services
delivered at less cost Benefits to the general practice – fulfilment,
education, upskilling, integrated healthcare community, more of a buzz!
Better patient and public engagement
BUT IT TAKES TIME AND EFFORT
Community Integrated Healthcare – An Approach by Whitstable Medical Practice
Transforming General Practice – Unlocking the Potential
Nuffield Trust, LondonWednesday 15 May 2013
Dr J M RibchesterExecutive & Senior Partner, Whitstable Medical Practice