18 weeks Transforming OPD using PBC

1
18 weeksTransforming OPD using PBC

• Charles Alessi
• Medical Director
• Kingston Cooperative Initiative
• charles.alessi_at_thamesdoc.nhs.uk

2
Practice based commissioning

• Practice based commissioning is this really
  voluntary? - new PCT role
• Practice based commissioning Making the link
  between clinical behaviour and financial
  consequence practice based budgets

3
18 week target

• PBC makes the process of referral much more
  important to an individual practice and
  clinician
• The end result is up skilling of the primary care
  practitioner and an enhancement in quality in the
  way the referral is made thus aiding the 18
  week attainment

4
Pathways and local variability

• A unique opportunity to ensure that patients get
  the best care in the best place by the most
  appropriate person
• Local sensitivity Primary care is not yet as
  predictable in the delivery of services as it
  could be.
• Appreciation of lack of sophistication within
  PCTs and perverse incentives within acute trusts
  as well as referrers

5
Enablers and Stallers

• Unbundling partially completing the pathways
  before the patients leave primary care
• Clinical assessment both intra practice and
  outside of the practice
• Payment by results - making acute provision
  more sensitive

6
Referrals KCI
change
GP
Introduction of KCAS
Total
C2C
Source QM08 data
7
Use of community based Out patients
Source KPCT data 2006/07
8
Public health assessments
Source KCAS data
Source KCAS data 2006/07
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Challenges

• How do we integrate public health assessment in
  the 18 week process more effectively to ensure it
  remains an enabler rather than a staller?
• How do we ensure C to C referrals are managed to
  ensure they remain enablers rather than stallers ?