slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
GERAINT WYNNE - JONES PowerPoint Presentation
Download Presentation
GERAINT WYNNE - JONES

Loading in 2 Seconds...

play fullscreen
1 / 64

GERAINT WYNNE - JONES - PowerPoint PPT Presentation


  • 149 Views
  • Uploaded on

GERAINT WYNNE - JONES. INDEPENDENT NOT from LHB NOT from TRUST NOT from OOH PROVIDER. DECLARATION OF INTEREST. (PERSONAL NOT FINANCIAL). WHEN ALL IS SAID AND DONE- A LOT MORE IS SAID THAN DONE. W.E.C.A.C. D.E.C.S DESIGNED FOR LIFE MAKING THE CONNECTIONS WANLESS 1000 LIVES

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'GERAINT WYNNE - JONES' - dafydd


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
geraint wynne jones
GERAINT WYNNE - JONES
  • INDEPENDENT
  • NOT from LHB
  • NOT fromTRUST
  • NOT from OOH PROVIDER
declaration of interest

DECLARATION OF INTEREST

(PERSONAL NOT FINANCIAL)

when all is said and done a lot more is said than done
WHEN ALL IS SAID AND DONE- A LOT MORE IS SAID THAN DONE
  • W.E.C.A.C.
  • D.E.C.S
  • DESIGNED FOR LIFE
  • MAKING THE CONNECTIONS
  • WANLESS
  • 1000 LIVES
  • FULFILLED LIVES,SUPPORTING COMMUNITIES
  • M.U.C.
  • TIME TO MAKE A DIFFERENCE
modernising unscheduled care m u c

MODERNISING UNSCHEDULED CARE M. U. C.

***************

The

Medusa of Unscheduled Care

understanding our medusa
UNDERSTANDING OUR MEDUSA
  • WHAT IS UNSCHEDULED CARE?
  • HOW BIG IS THE PROBLEM?
  • WHO ARE THE “SNAKES”?
  • $ 6,000,000 ? HOW?????
  • WHAT CAN PRIMARY CARE OFFER?
what is u c
WHAT IS U.C.?

ANY UNPLANNED HEALTH OR SOCIAL CARE TO PATIENTS WHO NEED HELP TO CARE FOR THEMSELVES AT HOME

WALES AUDIT OFFICE

NOVEMBER 2008

ANY EPISODE OF CARE PROVIDED FOR THE PATIENT WHICH IS UNPLANNED AND MAY REQUIRE PROMPT ACTION IN RESPONSE TO AN ACUTE, MINOR OR MAJOR INJURY OR ILLNESS WAG 2008

how big1
HOW BIG?

WALES 2007- PATIENT CONTACTS

A+E 740,326

NHSD 360,000

GP 2,650,000(ESTIMATED)

unscheduled care true perspective
FIRST CONTACTS

GPs 63.5%

NHSD 6.0%

A+E 5.5%

999 3.3%

MIU 1.1%

UNSCHEDULED CARE –TRUE PERSPECTIVE?
how big in 2031
HOW BIG IN 2031 ?

POPULATION WILL INCREASE BY 11%

PENSIONERS WILL INCREASE BY 31%

who are the snakes
WHO ARE THE “SNAKES”?
  • GPs
  • W.A.G.
  • TRUSTS
  • LHBs
  • WAST
  • NHSD
  • SOCIAL SERVICES
  • MENTAL HEALTH
  • PHARMACISTS
  • I.T.
  • PRESS
  • PATIENTS
  • SOLICITORS
w a g
W.A.G.
  • CONSTANTLY SEEM TO WANT TO BE SEEN DOING SOMETHING ABOUT THE POLITICAL HOT POTATO OF HEALTH
  • THEY ENCOURAGE THE “MEETINGS” CULTURE
  • THEY CREATE SOME OF THE U.C. PRESSURES
  • THEY NEED TO GIVE CLEAR GUIDANCE TO PATIENTS
  • THEY ARE OBSESSED WITH DATA AND EXERT NEEDLESS PRESSURE BY TARGETS
slide28
“Politicians use statistics like a drunk uses a lampost

for support not illumination” ANDREW LONG

slide29

Do A+E clinical staff feel able to deliver acceptable standards of service within the 4 hour target?Paul Stevens M.A. Business Management Thesis 2008

  • 95% front line staff felt that the imposition of the 4 hour target had negatively impacted on the clinical care of patients.
  • Pressure to meet time limit conflicted with professional care standards.
  • Quantitative care was secondary to qualitative care.
trusts
TRUSTS
  • HAVING A HARD TIME LATELY
  • HAVE MADE SOME VERY POSITIVE CHANGES
  • TENDENCY TO BE SELF – CENTERED
  • SOMETIMES ONLY PAY LIP-SERVICE TO THE CONCEPT OF CO-OPERATING WITH THE WIDER HEALTH COMMUNITY?
slide31
LHBs
  • LOCALLY “DISTANT”
  • IDENTITY CRISIS – REPRESENTING PRIMARY CARE - BUT ARE THEY?
  • PROPOSED CHANGES 2009 MAY IMPROVE LINKS WITH GRASS ROOTS
  • L.E.S. AND D.E.S. IMPACT ON PRIMARY CARE CAPACITY TO PROVIDE U.C.?
slide32
WAST
  • THE GLAMOUR BOYS (AND GIRLS) OF U.C. !
  • HARD WORKING
  • MADE BIG CHANGES TO WORKING PRACTICES
  • BEST USERS OF THE MEDIA TO ACHIEVE THEIR AIMS (SLIGHT PRIMA DONA COMPLEX?)
  • THE IMPACT OF EXTENDED ROLE PARAMEDICS ON U.C.?
slide34
NHSD
  • ON GOING IMPROVEMENT SINCE LINK WITH WAST
  • WHY NOT MORE POPULAR WITH THE PUBLIC?
  • WHAT SCOPE FOR INCREASING CALLS?
slide35
COMPUTER SAYS…….
  • CALL YOUR GP
  • DIAL 999
  • GO TO A+E
social services
SOCIAL SERVICES
  • A VAST ARMY OF “SNAKELETS” WORKING BEHIND THE SCENES
  • OFTEN VILLIFIED BECAUSE NOT AVAILABLE 24/7 AND NOT SEEN
  • A VITAL ROLE IN THE KEEPING IN, AND RETURNING OF PATIENTS TO, THEIR COMMUNITY
  • BACK INTO THE VIVARIUM OF HEALTHCARE?
mental health team
MENTAL HEALTH TEAM
  • A SMALLER GROUP OF PATIENTS BUT MORE TIME-CONSUMING OF STAFF
  • APPEAR TO HAVE DIFFERENT

TIME-SCALES TO THE REST

pharmacists
PHARMACISTS
  • MINOR AILMENT ADVICE MAY RELEASE CAPACITY IN PRIMARY CARE BUT NO DATA TO SUPPORT THIS SERVICE?
  • WHAT ABOUT MINOR AILMENT NURSES IN PHARMACIES WITH OPEN ACCEESS TO LOCAL GP SURGERIES?
slide39
I.T.
  • NOT FOR DATA COLLECTION BUT TO SECURELY SHARE PATIENT INFORMATION BETWEEN CLINICIANS
  • I.H.R.(INDIVIDUAL HEALTH RECORDS)
the media
THE MEDIA
  • A LOT TO ANSWER FOR !!
  • USEFUL COMMUNICATION TOOL
  • VIPEROUS – QUICK TO BITE,VENOMOUS AND NOT CHOOSEY ABOUT PREY !
  • COZY WITH WAST AT PRESENT - BUT BEWARE – KNOWN TO TURN ON THEIR YOUNG !
patients
PATIENTS
  • CHANGING DEMOGRAPHICS HAS MADE THEM VULNERABLE
  • NO LONGER SURE WHERE TO GO FOR HELP
  • WHY DO SO FEW ACCESS NHSD?
  • NEED GUIDANCE FROM W.A.G. AND PROFESSIONALS BEFORE THE EVENT
  • SIGNPOSTING
slide45
GPs
  • LOTS OF GOOD GPs - SOME BAD GPs
  • ADEPT AT JUMPING THROUGH W.A.G. HOOPS
  • ACCESS STILL A PROBLEM IN REALITY
  • LACK OF CAPACITY AN ISSUE – SMALL INCREASE IN GPs IN WALES
  • LACK OF MINOR ILLNESS NURSE PRACTITIONERS
  • TARGETS AND C.D.M. LIMIT U.C. CAPACITY
slide46
GPs

OUR ROLE HAS BEEN CHANGED BY W.A.G.

WE ARE NO LONGER DOCTORS OF

ILLNESS -

WE HAVE BECOME MANAGERS OF WELLNESS

others
OTHERS
  • SOLICITORS-

THE AMERICANISATION OF MEDICAL LITIGATION IS IMPACTING ON U.C. MANAGEMENT.

GPs ADEPT AT MANAGING RISK BUT BECOMING MORE DEFENSIVE MEDICO-LEGALLY-

? REASON FOR GP ADMISSIONS INCREASING- JUST LIKE CONSULTANTS IN A+E/AMU ADMITTING TO DECIDE NOT DECIDE TO ADMIT- SO PUTTING FURTHER PRESSURE ON THE SYSTEM

industrial model of care
INPUT

THROUGHPUT

OUTPUT

PRE –HOSPITAL

INPATIENT

DISCHARGE

INDUSTRIAL MODEL OF CARE
primary care team
PRIMARY CARE TEAM
  • EXPERIENCE
  • GENERALIST SKILLS
  • STABILITY
  • ADAPTABILITY
  • COMMUNICATORS
  • VALUED
gps in a e u c future
GPs IN A+E / U.C. - FUTURE
  • TRAINING -? GPWSI
  • SINGLE FRONT DOOR
  • I.H.R.
  • LINKED I.T.
  • ACCESS TO IN-HOURS APPOINTMENTS
  • ACCESS TO BOOK IN-HOURS SERVICES
primary care role in hours
PRIMARY CARE ROLE : IN-HOURS
  • INCREASE NUMBERS OF MINOR ILLNESS TRAINED NURSES TO RELEASE GPs TO DEAL WITH MORE U.C. CASES IN-HOURS
  • TRAIN RECEPTIONISTS TO FIELD CALLS MORE APPROPRIATELY – PROTOCOLS
  • FACILITATE CONTACT WITH OTHER TEAMS – LESS “US AND THEM”
  • EXPAND COMMUNITY GP BEDS
  • EXTENDED OPENING
  • GPs IN A+E / UNSCHEDULED CARE CENTRES
the edinburgh model

The Edinburgh model

Alastair Crosswaite

Alastair.Crosswaite@luht.scot.nhs.uk

slide55

CHANGE OF PHILOSOPHY

TEAMWORK

CO-LOCATION

GP BEDS @ DGH

PRIMARY CARE PHYSICIANS

Daily clinical sessions 5/7

Experienced generalist with primary care sensibilities in acute secondary care setting

Working at the primary/secondary care interface to manage patients in both directions

main objectives
Main Objectives

To Transform traditional ways of working:

  • Challenging existing pathways of care, and ways of thinking about care
  • Creating effective clinician to clinician dialogue
  • Highlighting the need for inter-dependence of all services that support patients
operational overview
Operational Overview
  • Monday- Friday 9am – 7pm
  • Covering and working from AMU
  • Take all community telephone referrals for

adult medical admissions, as well as providing advice to community based colleagues

  • Onsite advice/opinion to secondary care

colleagues

outcomes april 2007 march 2008
Outcomes : April 2007 – March 2008

Total Days of Service: 222

Total Calls taken: 3170

Total Patients under AGPS Care: 989

Admissions avoided 899 (28%)

AGPS OPDs 845 (27%)