Access to Primary Care (Advanced Access)
March 2002
Where DO We Want to Be?
...... NHS plan says it all
Good Attributes of UK General Practice(compared to international general practice)
Continuity of Care
Comprehensive Service
Coordinated service
first contact point of contact
ACCESS should be:
Universally available
Faster
More convenient
available for an extended range of services
Definition of Faster Access
NHS Plan Target : by 2004 pts will be able to see a primary care professional within 24h (doesn’t specify which professional) and a GP within 48h
What Does the Target Mean?
face to face contact only
covers only the GP and other first point of call professional
first point of contact can be any GP or health professional (eg the nurse)
applies during working days only
PCT responsibility
Faster Access....why????
high patient satisfaction rate BUT 1 in 5people cant get an appt and end up of A&E
20% felt waiting a top priority for the NHSPlan
25% wait more than 4 days
How Are We Going to Achieve It?
abolition of MPC
new funding formula
new contracts
more dr’s and staff (so they say!)
Implementation
top down throughPCT's
supportd by earmarked cash
SaFF's , PPF, QM
bottom up through NPCDT (national primary care development centres)
supported by local centres
“every system delivers exactley the results it is designed to give”
Where Might the Current Blocks Be? Looking at demand in the population:
Patient requests a service
CONSTRAINT
Access to that service
CONSTRAINT
delivery of that service
CONSTRAINT
access to secondary care
The Profile Of Demand :
Why Are Some Of Us Reluctant for Advanced Access?
- the fears….we are already overworked, stressed out and with a low morale.
- schedule already saturated (ie demand is too high)
- demand is insatiable (ie it will always be there!)
Components of Advanced Access
- understanding profile of demand
- adjusting the handling of demand
- matching capacity to demand
- contingency plans
How Can We Achieve This? Where can we direct the patient to? What Resources are out there?
NHS Direct, Pharmacy, Others
Self Help
PATIENT
The Web
Electronic Access
Appointment
Telephonequery
Immediate assistance
How Can We Reduce Face to Face Contact (ie reducing demand)??
- telephone follow ups - reduces face to face consultations
- telephone management of same day requests…don’t let the work build up
- email consultation and queries – lessens face to face contact
- reduce follow up on Mondays and Fridays….more spaces available on these days of usually heavy demand!
- advanced access reduces non attenders – they get an appointment when they need it!
Other Pre-requisites :
- work down backlog....locum cover etc
- match capacity to demand
- anticipate associated needs
- match team to work -who does it now, who could do it, what’s the next step in changing this?
- contingency plans – when things go wrong! - hospitals etc
Fundamental Questions
- what are we trying to do
- how will we know that a change is an improvement
- what changes can we make to result in an improvement
What are Others in the NHS trying to Do?
We know what GP’s are meant to be doing, but what will others that make up the NHS being doing to help?
The Government
is planning an extended range of services NHSPlan
up to 1000 specialist GPs
every patient will have access to a range of extended services delivered within primary care
consultants will be delivering approx 4 million outpatient consultations in primary and community care
GPSI's - GP's with a Special Interest
will have additional training and expertise to…..
take referrals from colleagues
Benefits of GPSI’s
for pts- high quality care more rapidly AND
- closer to home
for society - cost effective
- breaking down barriers
for GP’s- improved education (protected time out)
- contribute to recruitment and retention in general practice (as jobs become more exciting)
for Consultants - release consultant time to focus on more complex cases
for NHS - improved workload between primary and secondary care
Role of the GPSI
- to lead locality services eg a leader for cancer services through working with the generalist and specialist
- deliver a procedure based service
- to deliver an opinion or offer a clinical service
GPSI’s needed for : cardiol. , care of elderly, diabetes, palliative care etc
The Role of the National Framework
seting out minimum standards
developed by the RCGP in partnership
local health economies will be expected to work within the national frameworks but may include additional local criteria
The Role of the PCT's
identify tasks
take account of national priorities and local needs within a quality framework
appoint support and renumerate GP’s
shifting the balance...so that more power and resources are at the level of front linestaff
Primary Care Are Best Placed to Manage Resources and Power because :
They are local organisations
They are best placed at empowering clinical teams, communities and patients
They can provide a visible change
Pathways of Innovation
“Innovation moves through the system by tolerance to risk”
Rodgers , Moore 1993
Changing Behaviour
the adoption curve