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NEW Service. Central Cheshire PCT Dr Bill Forsyth. A Bit of History…. Once upon a time in a galaxy far, far away…… Historical Accident of GP OOH Cover On Call as it used to be……… Change of Landscape Shared Rotas Co-operatives New GP contract. Consistent Themes. Fear of Change

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new service

NEW Service

Central Cheshire PCT

Dr Bill Forsyth

a bit of history
A Bit of History…...
  • Once upon a time in a galaxy far, far away……
  • Historical Accident of GP OOH Cover
  • On Call as it used to be………
  • Change of Landscape
  • Shared Rotas
  • Co-operatives
  • New GP contract
consistent themes
Consistent Themes
  • Fear of Change
  • ‘What if you get busy?’
  • ‘I don’t want him looking after my patients’
  • ‘It’ll never work’
  • ‘Our system can’t be improved on’
  • Rapid normalisation/acceptance of new systems
  • Demarcation disputes - esp A&E
  • Lack of whole system approach
current position in central cheshire
Current Position in Central Cheshire
  • Population 250,000; 30 practices
  • 5 different sets of arrangements across PCT
  • 3 different Co-ops within PCT
  • 3 practices on boundaries with other PCT Co-ops
  • Concerns around Deputising Service used by 2 Co-ops
blocks in old system
Blocks in Old System
  • Insular, GP-dominated
  • ‘Can’t be improved on’
  • Lack of strategy/development
  • Poor IT use
  • Reluctance to work with A&E, other agencies
  • Lack of equity across PCT
initial survey results
Initial Survey Results
  • Indicated 100% GP opt-out
  • Indicated number of GPs willing to do some OOH work
  • Some times less popular than others
  • No surprises!
  • Status Quo - not viable
  • Existing Co-ops flexing to cover whole PCT - unwillingness to do so; high costs for same service covering same areas
  • Use of Deputising Service - quality concerns/cost
  • PCT run service
pct approach
PCT Approach
  • One element of GMS Implementation Plan
  • Linked to Emergency Care Network
  • Collation of Data on activity
  • Finance - available resources and costs
  • Group to oversee - appropriate Membership
  • Underpinning work-streams
  • Outline proposals for comment/revision
  • Process of continuing refinement of plans
outline plan
Outline Plan
  • NOT ‘more of the same’
  • NOT just a GP service
  • April 2004 start
  • Single PCT run service
  • Central Triage - robust, good quality
  • 2 main PCCs - VIN and Leighton Hospitals
  • Co-location/Integration with MIUs
outline plan1
Outline Plan
  • Service tailored to match demand
  • Service worked up in partnership with MCHT, MRAS, PT, SS
  • Involving other disciplines - paramedics, SS, NPs, DNs, etc. - skillmix
  • Evolving service - initially heavily GP-led
  • Gradual ‘growing’ of other staff
  • Close monitoring of demand, problems, etc. with appropriate adjustment to service
critical planning elements
Critical Planning Elements
  • Rotas
  • Recruitment - practices, GPs, salaried GPs, NPs, other staff
  • Finance
  • Not enough money in the system
  • ‘In generous baseline’ as usual
  • No option but to fund gap
other key elements
Other Key Elements
  • Will and Commitment
  • Communication, communication, communication
  • Public Consultation
  • Clinical expertise and input
  • Recruitment
  • Management and Organisational support
  • Pharmacy Minor Illness and Rep Rx Schemes
  • Shared working with neighbouring PCTs
shared pct working
Shared PCT Working
  • Other Cheshire PCTs
  • Adastra/Technical Links Programme
  • Sharing best practice
  • Cross-boundary issues
the future
The Future?
  • Evolving Service
  • Management Board to oversee service delivery/quality, shape and develop service
  • Appropriate membership critical
  • PCT commitment
  • Strategy/Innovation
  • Integration with A&E/MIU
  • Staff Training and Development
opportunities in pct run service
Opportunities in PCT Run Service
  • Ability to cope with Financial Risks
  • HR/Finance/Management Support
  • Removal of vested interest/demarcation disputes
  • Leverage to broker whole system change
  • Shared working
  • Easier to realise A&E/Minor Injuries, Ambulance Service benefits
  • Other organisations
mutual organisations
‘Mutual’ organisations
  • Some of ideas seductive
  • Should NHS be more like this?
  • Disparaging of PCT ability to provide service
  • Distrust/fear of PCTs
  • Could be described as ‘more of the same’ or attempt to preserve status quo
  • ‘Independence’ - good or bad thing?
from pct perspective
From PCT Perspective
  • Complicated/complex
  • Introduces another organisation
  • PCT remains responsible anyhow
  • Alternative is simplicity and control
  • Will this deliver integrated, whole-system working?
  • Lack PCT resources - ?long-term viability
  • Balancing risks and benefits
way forward
Way Forward?
  • Understand wide variations in Co-op and PCT maturity/skills/attitudes
  • Need to build relationships/trust
  • Many similar strands to proposals
  • Objectives should be the same
  • Likely to be variety of solutions
  • Does it matter as long as deliver?