POLYCLINICS LEARNING

1
POLYCLINICS LEARNING DEVELOPMENT
PROGRAMMEWorkshop 1
2
Introduction to the dayChristina Craig,
Polyclinics Project ManagerElaine Sutton,
facilitator
3
Todays programme
4
Polyclinics team

Senior Responsible Officer (SRO)
Heather OMeara
Clinical Expertise
Tom Coffey, Clin. Direc. Marilyn Plant, Clin.
Lead Deborah Colvin, Clin. Lead


Project Manager
Christina Craig
Senior Project Officer
Project Officer
Policy Manager
Project Administrator
Finance Officer
Sophie Coronini-Cronberg
Vanessa Layton
Ian Chislett
Miguel Godfrey
Jennie Bostock
5
The services

• GP
• GP Services
• - Consulting and procedure rooms
• - Dedicated child-friendly facilities
• - Core and extended GP services
• - Extended hours 8AM-8PM
• Practice Nurse services

• Community Services
• District Nursing
• Health visitors childrens services
• Midwifery
• Specialised therapies
• Outreach services (TB/HIV)
• End-of-life care
• Dieticians
• Available 12 hours

• Diagnostics
• ECG, Pulse Oximetry, Spirometry
• X-ray, U/S and Vascular Doppler
• CTG
• CT, MRI
• Colonoscopy
• Haematology, microbiology and pathology
• Available 18 24 hours

• Pharmacy
• Medicines use review
• Medicines management services
• Anti-coagulation services
• Dispensing services
• Available 18 24 hours

• Long Term Conditions
• Detection of undiagnosed
• Screening early detection
• Community matrons
• Management of disease registers
• Access to
• - Expert patient programme
• - Information prescriptions
• - Managers of complex needs
• Available 12 hours

• Outpatient Services
• Management of chronic illness (e.g. COPD, asthma
  and diabetes)
• Community paediatrics
• Consultant or PwS
• Mental health
• Audiology
• Chemotherapy
• IV transfusions
• Access to pain management
• Available 12 hours

• Other Healthcare Professionals
• Optician
• Dentist
• Other health professional
• Available 12 hours

6
The Shape of Today

• Introductions
• Exercises, presentations and discussions
• Opportunity to
• think creatively about the services that can be
  provided through the polyclinic model
• explore how the polyclinic model can provide
  maximum benefit to patients
• Tailor this programme to meet your needs
• Your views

7
HOW THE PROGRAMME CAN HELP USGroupwork
8
Group exercise

• Introduce yourself to the group
• Your name, your role
• Your thinking on polyclinics so far
• As a group, please discuss the following
• What questions do you want this programme to help
  you answer?
• What insights, skills and experience is your
  organisation able to offer others?
• Please post your contributions on the display
  boards provided

9
THE POLYCLINICS PROGRAMMEChristina Craig
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Purpose of programme

• To explore the polyclinic service model
• Examine how a model could be applied locally
• But not to implement the service model
• As commissioners you have undertaken to explore
  with us the
• full range of services
• different organisational models and their
  location
• range of commissioning models
• key enablers

11
Programme outline

• To support you in doing this we have developed a
  support programme. Its 3 key components are
• A series of 5 workshops covering key areas PCTs
  are expected to explore (previous slide)
• 3 underpinning workstreams
• stakeholder management
• legal issues
• financial modelling
• Individual meetings to understand local
  circumstances and thinking in more depth

12
Workshops

• The 5 workshops will
• be full-day events
• accommodate 2 participants per PCT
• provide relevant knowledge and technical
  information
• develop skills and capabilities
• share good practice
• facilitate co-development
• provide briefings re outputs to PCTs following
  each workshop

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Workshop 1

• Theme Introduction to the polyclinic vision
• Date Thursday, 1st May 2008
• Objectives
• explain the learning and development programme
• get feedback to tailor future workshops to needs
  and priorities of participants
• think creatively about the services which might
  be provided through a Polyclinic model
• explore how to ensure a Polyclinic model would
  provide the maximum patients and community benefit

14
Workshop 2

• Theme Key enablers and service issues
• Date Wednesday 21st May, 2008
• Objectives
• Explore some key enablers
• IT
• Workforce
• transport/access issues
• Discuss some of the service issues
• social care
• urgent care
• long-term conditions

15
Workshop 3

• Theme Exploring organisational models
• Date Thursday, 12th June 2008
• Objectives
• Create clear understanding of potential
  organisational and location models
• Identify possible models and explore advantages
  disadvantages of each
• Identify key enablers and constraints
• Identify what is required to operate the
  organisation and service model (e.g. governance,
  aligned incentives etc)
• Share information and facilitate learning

16
Workshop 4

• Theme Commissioning
• Date Thursday, 26th June 2008
• Objectives
• achieve clear understanding of possible
  commissioning strategies, inc. NHS rules for
  cooperation and competition
• establish pros cons of different approaches
• identify key enablers barriers
• present financial modelling work

17
Workshop 5

• Theme Key learning and next steps
• Date Wednesday, 9th July 2008 OR
  Thursday, 10th July 2008
• Objectives
• consolidate key learning
• discuss and address outstanding issues that
  surfaced during learning and development
  programme
• presentations by PCTs advanced in their thinking
  on how they might implement a pilot polyclinic
  service model
• agree next steps

18
Underpinning workstreams

• Three underpinning workstreams
• Stakeholder engagement.
• The Project Board continues to meet with key
  stakeholders (e.g. pharmacy, LMCs etc) to
  contribute to the development of understanding of
  the polyclinic service model
• Financial modelling
• External contractors designing a commissioner
  financial model for the polyclinic service model
• Legal issues
• Understanding LiftCo arrangements and other legal
  issues

19
One-to-one meetings

• The Polyclinic Project Team will meet with
  individual PCTs to understand local circumstances
  and thinking in more depth

20
Our expectations

• What we need from you
• attendance!
• your active contribution and participation
• willingness to share ideas and best practice
• to lead local thinking
• to complete the output report

21
Coffee break
22
Thinking creatively about services

• Groupwork

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Thinking creatively about services

• You have 4 mini-case studies
• Think about what would be needed to meet the
  needs of each person and to meet or exceed their
  expectations
• Select the appropriate cards
• Clinics interventions investigations
  health-related services
• Decide where each service should be located
• Write any comments or caveats on the back
• Place your cards
• If you have any time left over look at the
  remaining cards
• and place them too if you wish

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Discussion

• Plenary session

25
Lunch
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Delivering outcomes for patients

• Michael Faulkner

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Value in healthcare
The health outcomes achieved per of cost
compared to peers
Porter Teisberg 2006
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Benefits
NEED OR WANT
BENEFIT
FEATURE OF THE SERVICE
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Types of outcome

• Biomedical
• Stable blood pressure.
• Tumour completely removed.
• Patient reported
• I am free from pain.
• I can wash myself without assistance.
• Health
• Number of people falling over at home reduced
  from x to y.
• Number of citizens with morbid obesity reduced
  from x to y.

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Absence outcomes

• Number of patients experiencing avoidable or
  unexpected side effects ltx
• Number of patients requiring re-admission for
  same condition lty
• Number of patients acquiring infection
  post-operatively ltz

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Where do you measure the outcome?
?
?
?
?
?
Sustained Health improvement
Hospital episode
Community rehabilitation
GP
Problem solved
?
Readmissions? Complications?
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Examples of outcomes

• Wounds completely healed and no breakdown of
  tissue at wound site within 6 months.
• Patient reports that she is able to wash and
  dress herself without assistance and without
  discomfort.
• BMI is maintained within normal range over twelve
  months.
• Percentage of residents of Ashdown Estate who
  smoke lt 10
• of children receiving MMR vaccine gt 95

33
Patient experience measures

• Patient reports that all practitioners she saw
  were familiar with her circumstances and medical
  history.
• True in gt 75 of cases.
• age of appointments starting within 5 minutes of
  scheduled time gt 90
• All patients attending GU clinic offered choice
  of gender of clinician.
• Patients able to collect prescription on same
  visit gt 97

34
Case study outcomes

• For your four case studies
• What target outcomes and outcome measures would
  be appropriate?
• What standards for and measures of the quality of
  the patient experience would be appropriate?

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WILL POLYCLINICS MAKE A DIFFERENCE?

• Tom Coffey

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Heart failure now
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Heart failure future
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Out of hours care now
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Out of hours care future
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Homeless severe mental illness now
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Homeless severe mental illness future
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Psoriasis now
GP consultation
GP surgery
Consultant referral
Patient with poor English
Referral letter
CB
Wait list
Patient removed from wait list
Patient fails to respond
Letter sent requesting response w/in 7 days
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Psoriasis future
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Routine GP care now vs. future

• Currently
• List size 7000
• Surgery converted house
• Poor disabled access
• No extra facilities
• Half-day on Wednesdays
• No evening surgeries

• Future
• Working as a spoke to the hub
• PCT has facilitated investment in purpose-built
  facility 300m away
• Single-hander also on site
• Physiotherapy, phlebotomy spirometry services
• Evening surgeries

45
Any questions?
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ENSURING THE RIGHT PATIENT OUTCOMES

• Groupwork

47
Delivering the right outcomes

• How would we ensure that Toms patients have a
  high quality, fully integrated experience which
  delivers world class outcomes?
• Culture
• Training
• Workforce composition
• Facilities
• Technology
• Environment
• Processes
• Anything else

48
Review looking ahead

• How would you describe today?
• Any additional thoughts about future workshops in
  the light of your thinking from today?
• Please write on post it notes and leave on your
  table

49
SUMMARY, NEXT STEPS CLOSE

• Heather OMeara