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Stephen Ryan, PwSI Lead, Newquay, 2 nd March 2005 GPwSIs – National GPwSIs – National Perspective Perspective
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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
