Moving Services into Primary Care: Dermatology in Gwent

1
Moving Services into Primary Care Dermatology in
Gwent

• Adrian Thomas
• Head of Modernisation (Contracting and
  Development )

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How it started - thinking differently

• Lateral thinking
• Vertical thinking

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Lateral thinking

• What is currently being done in secondary care
  can be done in primary care?
• List the treatments
• What are the implications?
• Test the principles and implications

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Vertical thinking

• A Test.

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The Test

• FINISHED FILES ARE THE RESULT OF MANY YEARS OF
  SCIENTIFIC STUDY COMBINED WITH THE EXPERIENCE OF
  MANY YEARS.

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Evidence of Modernisation elsewhere

• A great deal of evidence!
• Main focus on
• Nurse led clinics
• GPsWSi posts
• Telemedicine

7
Principles

• It is about
• providing care in the most appropriate place,
  with the right skills and in a timely way
• shifting care from secondary to primary care
• a clinician led process
• ensuring that GPs meet their contractual
  commitments.

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The facts Gwent position

• Nearly 11,500 referrals per year
• Capacity around 7,500
• Requests for further consultant posts
• Waiting lists initiative costs estimated by Trust
  as over 700,000 to meet 12 months in 2005/06

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The Facts

• A forward-looking department
• Involvement of Primary care staff
• Consultant ratio FU to New of 1.1
• OP waiting lists pooled
• New Ops are partially booked

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Demand and Capacity modelling

• Exclusion and removal rates
• Suspension rates
• PTL scores
• Demand predictions

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The Potential impact of introducing new guidelines

• Evaluation estimates from studies in the Royal
  Gwent Hospital and information from elsewhere
  show a potential reduction of referrals overall
  between 12 and 35.

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The Challenges

• Clinicians
• 5 LHBs
• Inherited thinking
• Information

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Dermatology Referrals
Dermatology Guidelines for specific conditions
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Primary Care the infrastructure

• Understanding the contract
• Identifying skills

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The GP Contract

• Essential services
• Additional services
• Enhanced services

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The Future

• Further conditions into primary care
• Improved referral information
• Better demand/capacity planning
• Improved monitoring of GP Contract

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The Future

• Skilling Primary Care
• Involving patients wherever possible
• A root and branch review!

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Cant do this without..

• Lateral/vertical thinking
• Key Clinical champions
• Joint working

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End of presentation