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The Integrated Resource Framework. Dr Sheena MacDonald Senior Medical Advisor. Starting Point for the IRF… It’s not just about Finance Departments.

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The Integrated Resource Framework

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The integrated resource framework

The Integrated Resource Framework

Dr Sheena MacDonald

Senior Medical Advisor


The integrated resource framework

Starting Point for the IRF… It’s not just about Finance Departments

“Clinicians & Care Professionals.. have a crucial role... It is they who commit resources.” “Governance structures need to allow them freedom to act and to ensure there is accountability for their actions.”“Finance needs to be structured in a way that supports this.”

Prescription for Partnership

Audit Commission Dec 2007


Integrated resource framework context a perfect storm

Integrated Resource Framework Context - a perfect storm

Demographic pressures

Economic pressures

Planning in the margins of historic activity

Marginal or strategic planning?

Performance or variation?

Bottom line or opportunity cost?

Administration or stewardship?


The integrated resource framework

Integrated Resource Framework

  • Policy

  • Partnership working across health and social care

  • Shifting the Balance of Care

  • NHS Quality Strategy

  • Reshaping Care for Older People

  • Two planning disconnects

  • Within health – between primary/community and acute

  • Between health and social care

  • Need to shift resources to support shift towards better,

  • more appropriate care – and better outcomes


The integrated resource framework

Integrated Resource Framework

Triple Aim

  • IRF underpinned by the Triple Aim of a rational care organisation, defined by the Institute of Health Improvement (IHI) as:

  • Improving population health

  • Improving individual experience

  • Reducing costs

  • Each test site will use an “integrator” structure to direct resource use across health and social care and oversee progress towards the Triple Aim.


The integrated resource framework

Some supposedly simple questions:

Do you know how much you spend per head on people over 75 yrs?

Across Health and Social Care?

Is there variation:

by locality?

by GP?

in the type of care provided?

in outcomes?

Integrated Resource Framework


Diagnostics endoscopic

Diagnostics – Endoscopic

GP Referrals to all Nationally Reported Endoscopic Tests – April 08 to March 2009

12

10

8

GP Referrals by 500 Patients

6

4

2

0

F

A

B

C

H

G

E

D

J

I

T

K

P

V

Y

N

R

Q

U

L

S

O

M

W

X

GP Practice


Emergency inpatient admissions

Emergency Inpatient Admissions

Total Emergency Admissions to General Medicine, GP Acute and DME Beds by Practice - 2008/09

40

45

40

35

35

30

30

25

25

20

Distance from the BGH

Admissions per 500 of total population

20

15

15

10

10

5

5

0

0

A

B

E

C

D

J

L

F

T

K

P

S

V

X

Y

H

N

R

U

G

O

Q

M

W

I

Gp Practice

General Medicine BGH Emergency Admissions

DME Community & BGH Emergency Admissions

GP Acute Community & BGH Emergency Admissions

Out of Area Emergency Admissions

Mileage


Referrals to a e

Referrals to A&E

GP Referrals to A&E 2005/06 – 2008/09

Chart 17 - GP Referrals to A&E per 500 patients for 2005/06 to 2008/09

90

80

70

60

50

Referrals per 500 Patients

40

30

20

10

0

F

A

B

E

C

D

H

G

I

J

L

T

K

P

S

V

X

Y

Z

N

R

U

O

Q

M

W

Practice

2005/06

2006/07

2007/08

2008/09


Outpatient referrals

Outpatient Referrals

Comparison of Outpatient Referrals to the BGH and Out of Area by Practice for 2008/9

180

45

160

40

140

35

120

30

100

25

Referrals by 500 Practice Population

Mileage to BGH

80

20

60

15

40

10

20

5

`

0

0

I

J

L

F

T

A

B

E

K

P

S

V

C

D

H

N

R

U

G

O

Q

M

W

X

Y

GP Practice

Borders

Other Scottish

Other English

Mileage


Moving forward

Moving Forward…….

  • How do we engage clinicians

  • Where do we, as clinicians, influence the patient pathway and the concomitant distribution of resources

  • Where and how could we influence the patient pathway if the current constraints imposed upon us by lack of integrated resources were removed


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