1. Michael Maguire start

2. The Integration of Primary and Secondary Care
Michael Maguire, Linda Evans
North Glamorgan NHS Trust

3. Current Problems - General
Demise of Traditional 7/24 Family Practice
Junior Doctors’ Hours and Numbers
European Working Time Directive
Need for 7/24 service locally
Increased (Realistic) Expectations
Equipment
Specialised clinical skills (medical, nursing, PAM etc)

4. Current Problems - Particular
Variable GP qualities and interests
Many small/single person practices
Ageing workforce
Socio-economic
Urbs in rure
Deprivation and low health status
Increased morbidity
Decreased family ability to cope
Poor access

6. The current model - elective
Concerned Family
Tertiary services GP
DGH paediatric team
Community services

7. The Current Model - emergency
DGH paediatric team
Tertiary services GP
Health call
DGH ER
999
Concerned Family
Out of hours GP service/call centre

8. Requirement
Care should be provided as locally as possible provided that:
There should be easy and rapid access to high quality specialised care when needed
This specialised care should be provided as near to home as possible consistent with maintaining quality (and rational economics.)

9. Zeitgeist
The likely future divide is between those services which can be provided locally and those which require a specialised centre rather than between primary and secondary care.
“Getting more for their dollar: a comparison of the NHS with California’s Kaiser Permanent” BMJ 19 January 2002
“In Kaiser, primary care physicians include doctors accredited in …..paediatrics, and obstetrics and gynaecology………supported by physician assistants and nurse practitioners…”
“…some primary care physicians also follow their patients in the hospital setting”
Various editorial comment (ibid):
“Treating patients at the most cost effective level of care”
“The key answer is that …..Kaiser integrates care much more reliably than the NHS…”
“This vision - one integrated patient “journey” – is the right one for the NHS…”
“Kaiser may perform better because primary and secondary care are better integrated…”

10. The Proposed Model-emergency
Local paediatric team
Tertiary services
Concerned Family
DGH ER
999

11. The proposed model - elective
Concerned Family
Primary care team
Tertiary services
Local paediatric team

12. Function of the DGH
Reception, triage, resuscitation, stabilisation and transfer or return home of the sick or injured child. 24 hours 7 days
Support to the Maternity Service
Base for specialist out-reach clinics and services
Diagnostic services to local care teams

13. The New Model Paediatrician
CCST with general, community and neonatal experience (GP training?)
Works as a member of the primary care team
Ambulatory care
Health maintenance
Child protection
Works as a member of the local paediatric team to provide 24/7 emergency cover
Trains others

14. Questions

15. Summary Children’s care by children’s trained teams
Local care as far as possible
Appropriate access to (organ) specialist
Maintenance of local emergency care skills
Care by trained practitioners
Trainees on 1:1 apprenticeship model

16. Michael Maguire end