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PRIMARY CARE IN ENGLAND

PRIMARY CARE IN ENGLAND. Bradford City Teaching Primary Care Trust (tPCT). Lynnette Throp Chief Executive Fiona Clark Director of Nursing and Primary Care. About 25 minutes. Overview. National Context Bradford City tPCT Bradford City tPCT Statistics. NHS Facts and Figures.

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PRIMARY CARE IN ENGLAND

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  1. PRIMARY CARE IN ENGLAND Bradford City Teaching Primary Care Trust (tPCT) Lynnette Throp Chief Executive Fiona Clark Director of Nursing and Primary Care

  2. About 25 minutes

  3. Overview • National Context • Bradford City tPCT • Bradford City tPCT Statistics

  4. NHS Facts and Figures • NHS treats 1m people every 36 hours • Spends over £5million an hour • £74 billion a year • Employs more than 1 million people • By 2007-08 = 9.4% of GDP • Fastest growing health expenditure in EU

  5. Not true of the National Health Service!!!! • A system constantly in change • GP Fundholding and internal market – 1990’s • Primary Care Groups – 1999 • ‘Shifting the balance of Power’ – PCTs 2000 • NHS Plan – July 2000 • ‘Commissioning a Patient Led NHS’ – July 2005

  6. NHS Plan – July 2000 • Born out of record investment – 7.5% p.a.since 2003 • New hospitals, primary care centres, equipment • More staff – national pay system • New contracts – doctors, dentists, pharmacists • Nurse Consultants and Modern Matrons • National framework of standards and accountability

  7. NHS Plan – July 2000 • More choice, more contestability • Private sector concordat • National targets for reducing inequalities • Waiting time targets - A&E, GPs, Hospitals • Clinical priorities – cancer, rapid access chest pain, reduced waits for heart surgery, new mental health teams

  8. Things are getting better! • Waits for operation • No. patients waiting reduced by 2/3 • Longest waits now 6 months moving to 3 months • Out patient waits – 13 week maximum • Target – 18 week from GP to Treatment commenced • Routine appointment Primary Care professional – 24 hours • Routine GP appointment – 48 hours • Deaths from heart disease down by 14% • Deaths from cancer down by 6%

  9. Commissioning a Patient Led NHS – July 2005 • Targets have improved performance BUT STILL NEED TO: • Better respond to patient needs and expectations and deliver Choice • Incentivise accelerated improvements • Ensure sustained and systematic improvement • Strengthen commissioning

  10. ‘Commissioning a Patient Led NHS’ • Issued 28th July 2005 • In 2006 Strategic Health Authorities:28  10? • In 2006 Primary Care Trusts (PCTs) : 303  128? • Mostly co-terminous with Local Authorities • 100% Practice Based Commissioning - 2006 • PCTs provide services only by exception - 2008 • £250 million savings

  11. What will the NHS look like? Department of Health 10 Strategic Health Authorities • NHS Trusts • Acute • Mental Health • Foundation Hospitals • 128 Primary Care Trusts • GPs and their staff • Pharmacists • Dentists • Opticians • Community Services?? • NHS walk in centres • NHS Direct

  12. Demand Side Reform Supply Side Reform • Patient Choice • Practice Based Commissioning • Stronger PCTs • Choosing Health • Foundation Trusts • Plurality and Contestability • Independent Sector Transactional Reforms System and Regulation • Payment By Results • Information Strategy • Local Area Agreements • Performance Management • Process for service failure • Regulation

  13. What is a Primary Care Trust? • Patients registered with General Practitioners • Geography often difficult to determine • Now - Range from 60,000 to 350,000 population • Future - will be 200,000 to 2 million!!

  14. Primary Care Development Health Improvement Health inequalities Local area agreements Commissioning Secondary Care

  15. Expanding Local Services Sooner Nearer Earlier In Course Of Disease Cost Effective Use Of Resource Secondary Care URGENT CARE PLANNED • Minor procedures/ diagnostics in community settings • GPs with special interests • Walk in centres/Minor injuries units • Separation of ER • Out of hours services • Crisis resolution LONG TERM HEALTH IMPROVEMENT • Empowering self care • Case management • Integrated with Social Care • Intensive support for patients with complex conditions • Working with communities • Health and well being focus – Obesity, Smoking, Diet/exercise, sexual health, mental health • Reducing inequalities “….. the most intensive care in the least intensive setting” Primary Care

  16. BRADFORD CITY PRIMARY CARE TEACHING TRUST

  17. The Numbers • 150,000 Population – growing by 4% over next 20 yrs - 62% South Asian • £189m budget – around £6.5m under target • 800 Staff • 83 GPs in 41 practices – 19 single handed • 21 Dental practices • 31 Pharmacies • 22 Optician practices

  18. Key Challenges • Patients • People • Premises • Performance • Partnerships • Perfect Services

  19. 1. Patients • Patient involvement • Choice - empowerment • Patient education

  20. 2. People • 41% GPs over age 55 • 22% community nurses over 50 • At least 22 more GPs required • 10 practice nurse vacancies • Health Visitor position fragile

  21. 2. People • GP Recruitment & Retention • Dental recruitment & retention • PCT nurse support team • Medical students learning • in Primary Care • 3 S model ( Support, Security & Stimulation) • Lifelong learning

  22. 3. Premises • – 36 premises – 29 GP owned , 12 converted, 17 purpose built. Converted average age 84. • Replace with facilities which can deliver services appropriate for 21st Century Health Care • E.g. – LIFT project, New HQ, 11 GP’s moved from unsuitable premises

  23. 4. Performance • Healthcare Commission - Currently 2 stars • New system of self assessment and reviews including targets e.g. • Access times • Rates of chronic diseases • Patient survey results • Improving Working Lives – Practice Plus • RPST – External risk assessment • GP Quality Outcomes Framework (QOF)

  24. 5. Partnership • 4 PCTs in Bradford; 15 PCTs in West Yorkshire • Local Stakeholder involvement e.g. • Local Authority • Education Bradford • Voluntary Sector • Community organisations • Public, patients and carers

  25. 6. Perfect Services • ‘Every system is perfectly designed to give the result it gives’. • Pursuing six dimensions of quality/perfection: • - Timeliness - Efficiency • - Patient centred - Effectiveness • - Equity - Safety

  26. 6. Perfect Services • Six Characteristics • No unnecessary death or disease • No unnecessary pain or despair • No delay • No waste • No feelings of helplessness - patients or staff • No inequality in delivery

  27. BRADFORD CITY tPCT THE STATISTICS

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