Primary Care in NHS Grampian
By
Richard Carey
CE, NHSG
Introduction
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Policy drivers
Local direction setting
Why focus on Primary Care?
Primary Care – key themes
DQPC - Local successes and works in
progress
Planning
The way ahead…
Policy Drivers
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Equally Well
Healthcare Quality Strategy
DQPC – delivered by CHPs – NHSG supporting
Shifting the Balance of Care
Re-shaping care for older people
DoH White Paper – Liberating the NHS – Scottish implications
A revised GMS contract – Quality and productivity in PC
Optometric and pharmacy and contract changes
Dental changes
Delivering better outcomes and use of joint resources – audit of
CHPs
NHSG Local Direction Setting
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Healthfit /Grampian Health Plan
Developing Health and Care Framework –
transformational change – connect the levels
Patient Safety Programme – moving into
primary care
Developing Health Promotion Framework
Transformation plans - the Change Fund
CLINICAL LEADERSHIP and engagement
Why focus on Primary Care?
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The availability of primary care is
positively and consistently associated
with improved outcomes, reduced
mortality, lower utilisation of health care
resources, and lower overall costs of
care
Hallmarks of Primary Care
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First contact care, gate keeper of the health
system
Continuity of care, life long care?
Comprehensive care
Coordinated care, Integrates with acute care
and social care
Cost effective care
Part of a whole system – prevention to end of
life care
Key themes
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Access
Maximise Enablement and self care
Cared for in your own environment from cradle to
grave
Primary care focus on supporting self management,
care in the community, increasingly delivering more
complex care
Local accessible services
Specialist focussed on specialist care provision and
supporting the system to achieve the above
NHSG - Primary Care, key
themes
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NHSG enabling patients to “take control of the determinants of their
health” (enablement & self care)
NHSG supporting residents in their own homes (rehabilitation)
NHSG providing services in patients own homes and communities close
to friends and families
NHSG expanding primary care to deliver care to the patients – utilising
all contractor services and other care professionals - through Shifting
Balance of Care
NHSG expanding local and direct access diagnostic and treatment
services
NHSG providing care in acute settings (GP acute as well as secondary
care)
NHSG supporting contractors to deliver on their respective contracts
NHSG supporting access to primary care services – cross contractor
and cross discipline
DQPC -Local successes and
works in progress….
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Shifting the Balance of Care
Clinical leadership
Care pathways
Prevention and anticipatory care
Self care and self management
Patient safety
Challenges to making this happen
Local Successes – Shifting the
Balance of Care
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Minor Surgery
Diabetes
Eye health Network
GPs wSIs – eg orthopaedics, dermatology
Physiotherapist wSI, orthopaedics
Dental Practitioners with Special Interest - developing
Minor Injury Nurse service within Community
Pharmacy
Ultra sound scanning – shared training across GPs
and Consultant staff
The future – reshaping care for older people
Local Successes – Clinical
Leadership Locally
Aberdeen City Primary Care Redesign
 Moray Federation
 Aberdeenshire CHP Redesign
 Optometry Leads per CHP
 Dental Leads per CHP
 Pharmacy primary care redesign –
on-going
 PCIMG – cross contractor and service
leadership
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Care Pathways – under
development
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Cardiology
Dementia
COPD
MSK – national and local
Referral management pathways – various
Direct access diagnostics, eg endoscopy
Clinical guidance intranet (CGI)
Prevention and anticipatory
care……
Prevention and Anticipatory
Care
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Keep well
Well North
Anticipatory care LES
Alcohol brief interventions
Eye health checks
Toothbrushing/ Childsmile
Smoking cessation…
Keeping people at home – complex med mgt
Self care and self
management
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Know who to turn to…
Use of assisted technology
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COPD
Rehabilitation and re-enablement
Patient safety
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Medicines management – polypharmacy
review
Reducing healthcare acquired infection
– use of ‘4c’ antibiotics; hand washing
Improved communication between
primary and secondary care
Challenges…
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Finance
Infrastructure
Data management and information,
data quality
Performance management
Maintaining and improving cross system
dialogue
Finance!!!
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National Spending Review
Capital finance more limited
More challenging financial environment
SAW/SANE
CSI, Lean approach
Joint working with partners – Local
Authorities, Third Sector
Opportunity from challenge!
Infrastructure
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Premises in Primary care fit for
purpose?
Capital funds reductions
Impact from Hub Co
E-health connectivity – linking with all
contractor services in the community
Performance management
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QOF
ES reports
Dental registrations
Referrals to HES from optometry/GPs
CMS – MAS data
HEAT
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ABI
Health Checks
Child smile – Fluoride Varnishing
Smoking Cessation
Planning in Primary Care
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Developing process
Clinically led, managerially supported
Whole system focus
On-going dialogue
So……….
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Let’s think about Primary Care as the
solution
Let’s think about how we incentivise and
resource the system to work better for
patients and improve effectiveness and
quality
Significant change is needed – change role of
patient – passive to active…. Working with
communities and individuals
Significant change is needed around the way
we work together…
The way ahead…
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Engagement and involvement of Primary Care
Clinical Leaders; working across the system
Working in partnership with LA and Third
Sector colleagues, joint management models?
Transformational change of our workforce
Continual drive to improve quality – DQPC,
Patient Safety- within financial frameworks
Maximise self care and self management
Focus on patient pathways and anticipatory
care
Your turn…..
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Have your say and
Enjoy the day…