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Re-organisation of Primary Care Lyndon Miles Chairman Gwynedd LHB GP Bron Derw Medical Centre.

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Presentation on theme: "Re-organisation of Primary Care Lyndon Miles Chairman Gwynedd LHB GP Bron Derw Medical Centre."— Presentation transcript:

1 Re-organisation of Primary Care Lyndon Miles Chairman Gwynedd LHB GP Bron Derw Medical Centre

2 Outline Context, the wider NHS Improving Health in Wales Commissioning Primary care – Optometry – Dentistry – Pharmacy – General Practice Developing services locally

3 Context - Traditional NHS activities Comprehensive care delivery Mortality falling, patients healthier New drugs and treatments Technological improvements Funding increasing Alls well? – increasing demand – NHS failing to cope – WHY? – Whats happening to Health (rather than illness)

4 Inequalities in health – expectations of life MenWomen 1920s s s s7479

5 Inequalities in health – unequal expectations of life MenWomenFemale advantage 1920s s s s74795

6 Inequalities in health – SMRs SC1SCVRatio V:I 1920s s s s

7 Inequalities in health – mortality rates by economic activity ActivityRates per 100, Employed Unemployed Death rate ratio

8 Inequalities in health – Direct age standardised rate ratios by housing and car ownership TenureMenWomen Owner- occupier 1.0 Private rent LA tenant Cars1.0 No cars

9 Source: Whitehead M & Dahlgren G Inequalities in Health 1996


11 Partnership with Local Authorities

12 NHS problems Demography Demand / waiting times / capacity to cope Increasing specialisation Rising standards Morale / HR issues Financial issues Chronic disease management !!!

13 Secondary care System performance

14 Secondary care Rising standards (investigations and treatments)

15 Secondary care Rising standards (investigations and treatments) Rising demand, falling prevention

16 Secondary care Rising standards (investigations and treatments) Rising demand, falling prevention Dysfunctional system

17 How do we compare with other countries?

18 Life expectancyx Infant mortalityx Maternal deathx IHD SDRx CVD SDRx cancerx External injuryx SDR RTAsx Suicidex Best Worse UK Relative to 18 European countries

19 Health Personnel – comparison with Europe 1995 (per 1000 population) UKEU Physicians Dentists Nurses4.36.0

20 Country - spend on health care (% GDP) CountryUKFranceGermany14 EU Countries USA % GDP % GDP

21 Life expectancysx Infant mortalitysx Maternal deathsx IHD SDRsx CVD SDRsx cancersx External injuryxs SDR RTAssx Suicidexs Best Worse SWEDEN (UK) Relative to 18 European countries

22 Ranking of Health System Performance 2000 (WHO) France1 st UK18 th Germany25 th USA37 th

23 NHS national solutions Focus on health Job evaluation New contracts Re-organisation to improve efficiency

24 Better Health, Better Wales Life expectancy in Wales 3-4 years less Life expectancy (valleys) 5 years less Infant mortality, heart disease, cancers, LT illness all worse

25 Improving Health in Wales Reorganisation of structures New accountability arrangements Focus on partnership working Needs led / clearer mechanisms County HSC&WB Strategies

26 LHB Functions Corporate and Clinical Governance Securing and Providing Primary & Community Health Care Services Securing Secondary Care Services Improving the health of communities Partnership Public Engagement Provision of services

27 Healthcare Commissioning Needs assessment Address problems Service delivery analysis Review performanceConsider professional and commissioning plan / WAG guidance and views of clinicians & patients & stakeholders, Executive engagement Develop service commissioning with providers plans (including resource implications, public consultation if necessary)

28 Care pathway analysis Consider patients journey through system Allows holistic analysis, not organisational needs Identifies blocks, delays, inefficiencies, duplications etc Should improve patient experience and improve NHS efficiency

29 Primary Care Optometry Dentistry Pharmacy General Practice Diagnostics Estates IT

30 Optometry - The Future of Optometry Services in Primary Care in Wales Developed role – detection pathology / referral / monitoring – therapeutic treatment – Over 75 assessment / driving – Children – Specialist contact lens work – Occupational / sport eye care Schemes – Cataracts; glaucoma; low vision; minor problems etc Professional development IM&T, Premises, workforce planning

31 Dentistry – Routes to Reform Mixed economy Currently: Dental health worse than England; decline in children disappointing; marked inequalities; adults retaining teeth longer Challenges: High restorative need; new approaches to children; action re inequalities; fluoridation New Dental Contract LHB commissioning / local dental action plans 17% increase in training places in Wales Dental grant schemes

32 Pharmacy – Remedies for Success Need for integrated strategy Vision = co-ordinated service helping people to: – Maintain health – Manage common ailments – Best use of prescribed medicines – Manage long term medication needs Re-designing services Making best use of resources

33 Information Technology Informing Healthcare Single electronic record – Confidentiality project Workforce empowerment Patient and carer empowerment Service improvement Knowledge and information management

34 General Practice The Future of Primary Care – All primary and community based – Patient and public involvement (joint LHB / LA action) – CHC have statutory inspection rights over primary care (NHS Wales Bill – as from 1/4/04) – Address disadvantaged groups (through SAFF process) – Recognise work towards health (HLCs, H. Alliances) nGMS contract

35 _start.htm _start.htm Practice based contract Out-of-hours opt-out LHB commissioning Clinical governance / Chronic Disease management / organisational monitoring IT New GP Career structure

36 Changes to GP Chronic disease clinics Local additional / enhanced services e communications – Prescribing, dispensing, x interfaces, paperless, single records Resource centres Links with SS / care assessors / unified assessments Pathway developments Referrals analysis

37 Whats happening in Gwynedd? OOH Additional / enhanced Care pathways Extending roles within practices Promotion of primary care teams Estate strategy ?? Resource centre

38 Task? Advise on how a clinical service might be re- designed? – Agree which service (pick one that involves crossing boundaries) – Consider patients pathway – Any blocks / delays / skill-mix – Resource neutral (or limited)

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