Quality, Innovation, Productivity and Prevention (QIPP) Workshop

Document Sample
Quality, Innovation, Productivity and Prevention (QIPP) Workshop Powered By Docstoc
					Quality, Innovation, Productivity
and Prevention (QIPP)
Workshop 3 – Working together on
new Initiatives – MSK and LTC
• Wednesday 24th March 2010                  • Mike Murray –
• 2.00 – 2.50 pm                                 Programme Manager -
• 3.10 – 4.00 pm                                 Primary and Community
                                                 Care
• 4.15 – 5.05 pm                             •   Lee Hawksworth – Lead
• Heap Lecture Theatre                           Adviser – Tribal Group

24th March 2010   NHS Derby City Primary Care Event Presentation          1
Aims of
workshop
 • New initiatives – overview of areas
 • Focused area of delivery – MSK
 • Focussed area of delivery – LTC
 • Discussion



24th March 2010   NHS Derby City Primary Care Event Presentation   2
  New Initiatives - Overview
• Embedding innovation into Primary Care
    within NHS Derby City
                     MSK / Orthopaedic
                               LTC
                         Oral Surgery
                               ENT
                         Dermatology
                        Ophthalmology
                             Urology


24th March 2010   NHS Derby City Primary Care Event Presentation   3
MSK – why MSK, process
so far and principles
• Evidence gathering
• Ensuring size & scale of opportunity
• Ensuring quality improvement and financial
  efficiencies
• Consultation and developing consensus
• Shared decision making
• Shared responsibility and governance
24th March 2010   NHS Derby City Primary Care Event Presentation   4
                                                   Key Pathway: MSK
                                                                                          Impact
                Meeting the Challenge
                                                                        Health                Finance & Demand management
  MSK Clinical Assessment & Treatment Service            Standardisation of complex care       OP new demand
Delivering:                                              Equality of access                    OP FU demand
Triage of OP referrals                                  Delivering national clinical          planned surgical need
Joint injections                                        standards                              length of stay
Access to diagnostics                                    inappropriate patient journey       readmission rate
Community-based, post-intervention follow-up            Client-driven care & goal setting
Deflection-point for T&O-related urgent care            Delivering patient reported
Supported by agreed referral criteria and minimum       outcome
datasets i.e. PLCV                                         client satisfaction
Direct listing for surgery following plain film x-ray   Improved wellbeing




                     Falls Prevention                      morbidity & mortality              unplanned care
Falls clinics in the community, offering:               Prevention focussed                   OP new demand
Gait analysis                                            morbidity & mortality               OP FU demand
Optometry                                               Client-driven care & goal setting     length of stay
Physiotherapy                                           Delivering patient reported           readmission rate
Osteoporosis assessment                                 outcomes
                                                           client satisfaction
                                                           wellbeing




    24th March 2010                          NHS Derby City Primary Care Event Presentation                               5
                                                    Key Pathway: MSK
                                                                                       Impact
               Meeting the Challenge
                                                                     Health                Finance & Demand management
             Pain Management Service                     access to psychological           OP new demand
MDT Chronic pain service (including consultants)      therapies                             OP FU demand
Including medically unexplained care / support          wellbeing                         prescribing costs
Access to supporting psychological therapies          Standardisation of complex care
Community-based                                       Equality of access
                                                       Delivering national clinical
                                                       standards
                                                         inappropriate patient journey


              Direct Access Diagnostics                Standardisation of care               OP demand
Direct access to a range of diagnostics for primary   Equality of access
care                                                   Delivering national clinical
Interpretation and support                            standards
Supported by agreed referral criteria and minimum       in inappropriate patient journey
datasets i.e. PLCV


 Review & redesign of existing FT Rehab services     Standardisation of care              surgical demand
Enablement of community-based care where             Equality of access                   OP
appropriate:                                         Delivering national clinical       Optimised contract value:
Maximising of contract: reflecting PLCV             standards                           Maintained costs for increased
Reducing OP demand                                    inappropriate patient journey   output
                                                       morbidity & mortality             costs for maintained output
                                                     Delivering patient reported          costs for increased output
                                                     outcomes
                                                       client satisfaction
    24th March 2010                        NHS Derby City Primary Care Event Presentation                                6
LTC – Why LTC, process
so far and principles
• Evidence gathering
• Ensuring size & scale of opportunity
• Ensuring quality improvement and financial
  efficiencies
• Consultation and developing consensus
• Shared decision making
• Shared responsibility and governance

24th March 2010   NHS Derby City Primary Care Event Presentation   7
                                                            Key Pathway: LTC
                                                                                                                      Impact
                            Meeting the Challenge                                                                         Finance & Demand
                                                                                                 Health
                                                                                                                             management
                      LTC Care: Disease Management                                      Standardisation of care      unplanned care
Health coaching for those with LTC                                                                                   OP demand
Care co-ordination                                                                     Equality of access
Self care enablement                                                                                                 length of stay
Self management / care plans                                                           Delivering national
Underpinned by self care enablement, education of support                              clinical standards            readmission rate
Including:
                  Disease Management: Community Heart Failure Care                        inappropriate patient   prescribing costs
                                                                                        journey
Specialist Nurse-led community-based provision of complex heart failure
management
Including palliative care provision                                                      morbidity & mortality
                    Disease Management: Complex Respiratory Care
Ambulatory or community / primary care management                                      Client-driven care
MD COPD Clinical Teams: Nurse specialists, GPwSI – triage / follow-up
Hospital-at home: Patients with acute exacerbations of chronic obstructive pulmonary   Client goal setting
disease (COPD) are treated at home instead of being admitted to hospital.
Medication compliance clinic                                                           Delivering patient
Prevention clinics – smoking cessation, exercise prescriptions, Flu jabs               reported outcomes
Physiotherapist led pulmonary rehab
Community-based comprehensive rehabilitation for those with moderate COPD               client satisfaction
              Disease Management: Complex Community Diabetes Care
MDT community-based complex disease management                                           wellbeing
Insulin initiation
Pre-pregnancy counselling
Complex foot disease management
Specialist dietetic care
Diabetic Retinopathy service
Support of general practice in diabetes management
Provision of client support, education and self care enablement
Support for Nursing and Care Homes in diabetes care
    24th March 2010                               NHS Derby City Primary Care Event Presentation                                             8
                                                              Key Pathway: LTC
                                                                                                          Impact
               Meeting the Challenge
                                                                             Health                          Finance & Demand management
              Easy Access 1-stop Diagnostics                  Standardisation of care                    unplanned care
Community provision & interpretation of related diagnostics   Equality of access                         OP demand
i.e.                                                          Delivering national clinical standards     length of stay
Spirometry                                                     inappropriate patient journey           readmission rate
Plain film x-ray                                               morbidity & mortality via improved    ECG:
Pulse-oximetry                                               diagnosis of disease and subsequent       GPs referred 16% fewer patients to A&E
Exercise Testing                                             management                                7% of admissions avoided = £4000 per GP practice
ECG                                                            client satisfaction                   Event Recording
Event recording                                                wellbeing                             AF: e.g. PCT, 34,201 screened
24 hour BP                                                                                             -5Strokes prevented in year @ £44,000 each
BNP                                                                                                    -Annual cost saving (recurrent): £220,000.
Supported by referral criteria & minimum dataset i.e. PLCV                                             -Return on investment: 322%
                        Telemedicine                           Standardisation of care                   unplanned care
Increased utilisation of telemedicine to support LTC          Equality of access                        OP demand
management                                                       morbidity & mortality                  readmission rate
Self care enablement                                            wellbeing
Including                                                      Client-driven care
Weight monitoring: Heart Failure care                         Client goal setting
Blood sugar monitoring: Diabetes care                         Delivering patient reported outcomes
Symptom monitoring: COPD                                        client satisfaction
                                                                 wellbeing
                      Cardiac Rehab                            Standardisation of care                  unplanned care
Community-based comprehensive rehabilitation for those Equality of access                              length of stay
post MI / surgery, heart failure, angina & peripheral arterial Delivering national clinical standards   readmission rate
disease                                                          inappropriate patient journey
Underpinned by self care enablement, education of               morbidity & mortality
support
                                                               Client-driven care & goal setting
                                                               Delivering patient reported outcomes
                                                                 client satisfaction
     24th March 2010                                             wellbeing
                                                       NHS Derby City Primary Care Event Presentation                                                  9
                                                                  Key Pathway: LTC
                                                                                                            Impact
               Meeting the Challenge
                                                                              Health                           Finance & Demand management
               One-stop Renal MDT clinics                      Standardisation of care                    unplanned care
Consultant-led clinics / day-treatment facilitates            Equality of access                         OP demand
Platelet transfusions                                         Delivering national clinical standards     length of stay
Community peritoneal dialysis beds                              inappropriate patient journey           readmission rate
Vascular Access Procedures (Patients only attend                morbidity & mortality
hospital twice)                                                Client-driven care & goal setting
Home / local dialysis                                         Delivering patient reported outcomes
Provision and support of palliative care needs                  client satisfaction
Supporting general practice CKD care                            wellbeing




         MI & Post cardiac Surgery / Procedure                 Standardisation of care                in length of stay and a reduction in the requirement
Restructuring local networks and services to reduce           Client-driven care & goal setting    for cardiology beds on average by 2 days per patient
inpatient stay for non-elective cardiac patients to a target   Delivering patient reported outcomes
of 21 days for patients who need coronary artery bypass          client satisfaction
grafting, or five days for those needing angioplasty
                                                                 wellbeing


                     Stroke & TIA                              Standardisation of care                    average length of stay; Earlier discharge to home.
Stroke & TIA pathway redesign, including:                      Equality of access                         unplanned care
ABCD2 clinical assessment by clinicians, inc. GP’s, PN        Delivering national clinical standards     time in A&E
& A&E staff                                                      inappropriate patient journey           readmission rates
TIA: Access to diagnostics                                      morbidity & mortality                 Average LOS savings at a trust level equates to
Early supported discharge team                                Client-driven care & goal setting        £250,000 for reducing the length of stay by 5 days at
Community-based provision post stroke rehabilitation          Delivering patient reported outcomes     £250 per bed day
                                                                 client satisfaction
                                                                 wellbeing



     24th March 2010                                   NHS Derby City Primary Care Event Presentation                                                       10
                         Pathway Management




                                                                             Referral
                                                                              point
                        Self              Primary         Community
                       referral            Care             Care

   Key Factors




                                                                             Choice
                                                                              point
    CAB delivery         Pathway Management Service

 Managing capacity


Contract management                Universal / General Care




                                                                               Care Provision
Managing performance

                                        Specialist Care
       KPIs:
  Health outcomes

   Access: Equity
                                  Highly Complex / Acute Care

                                                                  Tertiary
                                                                   Care
                  Other initiatives
• Embedding innovation into primary care
      – PBC lead projects
      – Urology
      – ENT
      – General Surgery
• Business as usual in Primary Care
      – Ophthalmology
      – Core Plus

24th March 2010     NHS Derby City Primary Care Event Presentation   12
Now over to you …


              • Questions
              • And points for discussion




24th March 2010        NHS Derby City Primary Care Event Presentation   13
Group 1

      Quality     Innovation    Productivity     Prevention



1st             1st            1st             1st



2nd             2nd            2nd             2nd



3rd             3rd            3rd             3rd
Group 2

      Quality     Innovation    Productivity     Prevention



1st             1st            1st             1st



2nd             2nd            2nd             2nd



3rd             3rd            3rd             3rd
Group 3

      Quality     Innovation    Productivity     Prevention



1st             1st            1st             1st



2nd             2nd            2nd             2nd



3rd             3rd            3rd             3rd
Group Summary

      Quality     Innovation    Productivity     Prevention



1st             1st            1st             1st



2nd             2nd            2nd             2nd



3rd             3rd            3rd             3rd
Last Slide (in first 2 workshops)

• Thank you for participating in this workshop
• Tea and Coffee is now being served in… ????
  Location
• Please help your selves taking your
  refreshment into the next workshop
       Workshop                                          Location
       1 – PBC Working                                   ????
       2 – QIPP in Primary Care                          ????
       3 – New Initiatives                               Heap Lecture Theatre
       4 – Urgent Care                                   ????

   24th March 2010                NHS Derby City Primary Care Event Presentation   18