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GP Update 31st March 2011Steve Kirk
GatNet Vice Chair
• Board Update• Commissioning and new contract• Practical steps to help practices review
commissioning data and reduce referrals
GatNet Board• Chair Dr Mark Dornan• Vice Chair Dr Steve Kirk• Prescribing Lead Dr Chris Jewitt• Good Medical Practice Dr Neil Morris• Urgent Care Dr Gordon Orritt• Nurse Representative Voting in Progress• Practice Managers Val Hempsey, Susan
Sohi,Sheinaz Stansfield
• PCT executive director TBC• PCT non-exec director Alan Baty• Public Health representative Alyson Learmonth
Co-opted members• Prescribing Lead Anne-Marie Bailey• PCT Commissioner Jane Mulholland
+ (clinical leads in MSK, Dermatology, COPD, Sexual Health, etc.)
Changes to Contract
• Patient participation DES– Patient reference group– Agree priorities, local survey, action plan,
publicise plan and actions • Changes to QOF
– Emergency Admissions 47.5 points– 1st outpatient referrals 21 points– Prescribing 28 points
Question 1
How do we reduce numbers of routine referrals to secondary
care?
Reducing Routine Referrals
• What has been tried– Referral management schemes– CATS– Financial incentives– Peer review– Triage– Guidelines and proforma letters
• What can Practices do?– Know your referral patterns, how do you
compare?– What are your high referral areas?– What are the quality of your referral letters?– Do you use in house referral?– Have you had consultant feedback– Do you use peer review– Are you prescribing effectively?
Reducing Routine Referrals
• What can Practices do?– Use alternatives to referral to hospital– Intra-practice referral– Understand what patient wants from referral– Consider explicitly stating purpose of referral,
ie management plan and discharge, diagnosis, treatment
– Understand and manage variation within practice
Reducing Routine Referrals
• What can GatNet do?– Facilitate peer review/consultant review
• Targeted or general
– Develop alternatives to referral– Provide comparative data– Develop proformas/guidelines– Training
Reducing Routine Referrals
Question 2
How do we reduce numbers of emergency admissions?
• What has been tried?• Nuffield Trust report• UCT• Community matrons• Risk modelling• Assisted discharge• Community support workers
Reducing Emergency Admissions
• What can Practices do?– Know the patterns/high risk areas– Triage of home visits– Good links with nursing homes– Effective patient information and LTC
management– Use alternatives to referral– Look at pressure areas– End of Life Care
Reducing Emergency Admissions
Rate of emergency hospital admissions due to COPD per
100,000 people all ages
0
100
200
300
400
03/04 04/05 05/06 06/07 07/08Year
Ra
te p
er 1
00
,00
0
Gateshead NE England
Rate of emergency hospital admissions due to COPD per
100,000 people all ages
0
100
200
300
400
03/04 04/05 05/06 06/07 07/08Year
Ra
te p
er 1
00
,00
0
S Tyneside NE England
Rate of emergency hospital admissions due to COPD per
100,000 people all ages
0
100
200
300
400
03/04 04/05 05/06 06/07 07/08Year
Ra
te p
er 1
00
,00
0
Sunderland NE England
Rate of emergency hospital admissions per 100,000 population due to COPD (ICD10 J40-J44), directly age-standardised admission rate, persons all ages
Gateshead Practices: Emergency COPD Admissions per 100 Patients on Disease Register
Period/Year: Rolling Year - 2008/2009; Cost
Fell Cottage total cost £59,961
Beacon View £17, 020
Age-standardised rate of emergency hospital admissions due to COPD per 100,000 among people of all ages in 2007/08
245
198
135
196
141
0
50
100
150
200
250
300
Gateshead S Tyneside Sunderland NE England
Ra
te p
er
10
0,0
00
pe
op
le a
ll a
ge
s
Source: Admission rates taken from Association of Public Health Observatories, Hospital Episode Statistics Atlas at www.apho.org.uk
Clinical Area Total Admissions
Admission Process
Non-infective gastro and colitis
6 A & E 3Minor injuries/Gatdoc 2MAU no GP involvement 1
AF and flutter 3 GP 1? GP 1Care of Elderly clinic 1
UTI 6 A & E 3GatDoc 1MAU/GP involvement 1GP 1
Acute LRTI 4 GP 4
Chest Pain 11 A & E 4GP/MAU 2GP 3No discharge info 2
Syncope 6 A & E 1GP 3No discharge info 2
COPD with acute LRTI
2 A & E 1No info 1
Special Screening 11 A & E 2MAU 1GP 5No Info 3
Abdominal Pain 6 A & E 1GatDoc/WIC 4GP 1
Lobar Pneumonia 5 GatDoc 1GP 4
• What can GatNet do?– Improve effectiveness of support teams– Develop alternatives to admission– Integrate WIC/A+E– Work with Gatdoc and UCT– Identify and reduce the variation in how often
best practice is being offered to patients– “Universalise the best”
Reducing Emergency Admissions
Question 3
How do we reduce attendances at Walk in Centre and Accident and
Emergency?
Reducing A+E/WIC attendances
• What can practices do?– Understand data– Ensure practice access is good
• Primary Care Federation work• Same day/advance appointment ratio• Telephone answering systems• Appointment availability
– Psychological support in some case– Use Dashboard
• What can Gatnet do?– Support practices to improve access– Ensure access to information– Simplify options for patients who are seen out
of hours– Develop alternative pathways
Reducing A+E/WIC attendances
Question 4
How do we manage those who are “frequent attenders” to secondary
care?
Managing Frequent Attenders to Secondary Care• What has been tried?• Risk assessment• Integrated care teams• Self Care• Need all three in place to have an impact
• What can practices do– Use Dashboard– Case management– Identify and treat psychological problems– Work with Nursing Homes
Managing Frequent Attenders to Secondary Care
• What can Gatnet do?– Provide information systems– Facilitate change in General Practice – Work with UCT etc to ensure support for
patients available– Ensure community matrons working
effectively– Resource changes that are needed in primary
care– Improve links with Social Care
Managing Frequent Attenders to Secondary Care
Take home messages
• Discuss in your practices• Use the tools that are available• Ensure access is as good as possible• Use the services that exist to reduce
referral to secondary care and admissions.• Universalise the best
