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MANAGING THE DEMAND

MANAGING THE DEMAND. Dr Gerry Beattie 19 th May 2010. Demand management - definition. Actions taken by primary care/trusts and/ or GP practices to moderate the demand for health care services

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MANAGING THE DEMAND

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  1. MANAGING THE DEMAND Dr Gerry Beattie 19th May 2010

  2. Demand management - definition • Actions taken by primary care/trusts and/ or GP practices to moderate the demand for health care services • Hospital demand management refers to actions taken to moderate the rate of referrals of patients to hospitals NHS Evidence

  3. Demand • Demand is not a given – it can be influenced • Demand is constantly changing • As waiting times come down demand may rise • In some main specialities demand is rising eg. ENT, neurosurgery, urology

  4. To manage demand - • The interface between primary and secondary care needs to be managed • There is a need to assume a corporateownership of patient pathways through primary and secondary care

  5. Demand It’s all very well saving 10 pence in the pound, but perhaps what’s more important is who spends the 90 pence Kings Fund

  6. Management and demand at the interface between primary and secondary care. Angela Coulter, Director of Policy and Review, King’s Fund British Medical Journal (1998) Vol 316, 1974 - 1976

  7. Why do GPs refer ? • Diagnosis • Investigation • Advice on treatment • 2nd opinion • Reassurance for the patient

  8. Continued ; • Sharing the load or risk of treating a difficult or demanding patient • Deterioration in the GP/patient relationship leading to a desire to involve someone else in the management of the problem • Fear of litigation • Direct request from patient or relative

  9. ‘Collating information and feedback are important first steps in the understanding of patterns of demand ‘ Coulter

  10. Appropriate referrals • Necessary • Timely • Cost effective • Effective

  11. What’s referred most - • Joint pain • Hearing problems • Abdominal pain • Back pain • Breast lumps • Varicose veins • Visual problems • Menorrhagia

  12. Continued • Sterilisation / vasectomy • Skin conditions • Depression • Termination of pregnancy • Tonsils • Otitis media • Cataracts

  13. Managing Demand 1. Knowing demand and flexing capacity 2. Advice only referrals 3. Ref help 4. Speciality GPs 5. Direct access

  14. 1. Knowing demand and flexing capacity • Gynaecology – unclear what the demand was in terms of numbers and case mix • Waiting time for GOPD was 16 weeks • 6 entry points into the system all with separate booking systems – NRIE, WGH, SJH, LCTC, Roodlands, Liberton • Inequity of access and double slotting

  15. Centralised Booking • Referrals redirected on SCI Gateway to one central office in NRIE. • Patients seen by most appropriate person at the most appropriate site. • Ability to respond to pressures and better utilise specialist clinics with more effective use of capacity. • Waiting time for GOPD approximately 6 weeks across Lothian without additional capacity. • Prospective capacity modelling tool

  16. Audit of referrals

  17. DNA’s Grade↓ • Sterilisation requests • Menorrhagia • Pelvic pain • But approximately 70% of DNAs are return patients Grade↓ Pathway → Grade↓ Pathway → Grade↓

  18. DNA Rate

  19. 2. Advice only referrals • Examples in various specialities that this works well eg dermatology • SCI gateway ‘advice only’ referrals being developed and piloted in gynaecology • Ultimately linked to TRAK • Demand needs to be monitored closely • Manpower needs to be in place in secondary care to deal with such referrals

  20. 3. Ref help • On line referral support • Perceived as ‘user unfriendly’ at present • Services need to take ownership • Use as a shop window with up-to-date referral help and advice

  21. 4. Speciality GPs • Identify GPs with speciality interest to work with secondary care • Protocol and pathway development • Focus for information dissemination and feedback in both directions • Develop educational initiatives • Consolidate links between primary and secondary care

  22. 5. Primary Care Access Removing access restrictions and jointly redesigning primary/secondary care interface processes can improve the whole patient journey

  23. Primary Care Access • Expand the range of diagnostic tests available in primary care • Direct access bookable slots in secondary care • Reduce referrals to secondary care and enhance local care

  24. Primary Care Access • Echocardiography • Ambulatory BP recording • 24 hour tapes • Full pulmonary function testing • CT/MRIs of knees, chest, neck, abdomen

  25. MRI lumbar spine – the Tayside experience (April – Sept 2009) • GP-OP-MRI-OP vs Direct access GP-MRI 34% GP-MRI-OP 66% • GP to OP to MRI to OP - 24 weeks GP to MRI to OP - 12 weeks • Out patient attendances dropped by 66%

  26. Questions ?

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