Stephen Ryan, PwSI Lead,

Newquay, 2nd March 2005

GPwSIs – National PerspectiveGPwSIs – National Perspective

The new NHS Patient choice Demand management Targets and Ratings Secondary to primary care shift Clinical governance/Quality Key role for PCTs? Access Patient pathways

The NHS Plan

Section 12 “Cutting Waiting for Treatment” “up to 1,000 specialist GPs will be taking

referrals from fellow GPs for conditions in specialties such as ophthalmology, orthopaedics, dermatology and ear nose and throat surgery. They will also be able to undertake diagnostic procedures such as endoscopy.”

GPwSI definition -1 (DoH/RCGP) “GPwSIs supplement their important

generalist role by delivering a high quality, improved access service to meet the needs of a single PCT or group of PCTs. They may deliver a clinical service beyond the scope of normal general practice, undertake advanced procedures or develop services.”

GPwSI definition -2 (DoH/RCGP) “They will work as partners in a managed

service not under direct supervision, keeping within their competencies. They do not offer a full consultant service and will not replace consultants or interfere with access to consultants by local GPs.”

GPwSI - key points

Provide full range of GMS/PMS services to their own patients

Take referrals for patients previously referred to secondary care

or provide enhanced service for particular conditions or patient groups

additional training and expertise

Nurses with a Special Interest

“..may work across a number of practices providing a secondary care service..”

“..an outreach basis…supporting patients with chronic conditions in the home..”

“..may combine a more general role..as a district or practice nurse…with expertise in diabetes..”

Dentists wSI

“..works within the limit of their competency in providing a special interest service…refers on where necessary.”

“..a service complementary to secondary services..”

“..enhanced services with improved access..”

General Practitioners Nurses Allied Health

Professionals Scientists Dentists

Practitioners with Special Interests

Optometrists ? Pharmacists? Practice Managers?

Practitioners, Patients, PCTs

Job satisfaction Recruitment and retention Primary care capacity Faster service access More local services Choice

Clinical Framework examples

Diabetes Dermatology Mental health Epilepsy Headaches Drug misuse Child protection

Genetics Public health

Step by Step guides Generic frameworks Clinical frameworks National database Risk Assessment Guidance Impact Assessment Tool

Practitioners with Special Interests Resources

Impact Assessment Tool

Objectives – waiting times, patient choice, length of stay, hospital readmissions

Activity measures – appointments, sessions, DNAs

Tools – patient diaries, HNA workbook, satisfaction tools, interview toolkits, Quality of Life indicators

Work in progress

Practice managers framework Document Map Pharmacy paper Accreditation models GPIAG Resource Pack PCT and SHA activity

Document Map

Project board terms of reference SLAs, contracts Job descriptions Clinical guidelines Referral forms Room specifications Audits

Step-by-step……Shared Care

Service review Health needs Demand and capacity Steering group Service scope Remuneration Clinical governance Audit and evaluation

York Health Economics Consortium ( Sep’02) 30-40% of ENT referrals could be seen by

GPwSI GPwSI discharges 70-80% of patients

back to own GP Low DNAs ( typically 1-2%) GPwSI seeing 9-10 patients per week, will

have 420-500 consultations per annum

Quicker Treatment Closer to Home (Audit Commission) Service redesign not mainstream PECs need to drive service redesign 36% of PwSI services by one professional SHA catalyst role Shortage of clinicians for PwSI PCTs need to involve a greater range of

healthcare professionals

GPwSI….weaknesses

Clinical information systems CPD in contracts Access to consultant support for problem

patients Clinical governance responsibility Costings Funding for support and admin

What next?

The NHS Improvement Plan Payment by Results Tier 2 Greater Manchester Health Foundation Report Practice-based commissioning Accreditation model(s) USA and LTC

Contact details Stephen Ryan

Stephen.Ryan@doh.gsi.gov.uk

Mobile: 07887 718391

www.natpact.nhs.uk