Primary Care in the United Kingdom Dr Mike Burrows Chief Executive Salford Teaching Primary Care Trust 1 “adding life to years and years to life IN Salford”
Primary Care Background • United Kingdom four separate healthcare systems • England – 152 Primary Care Trusts • A financial allocation direct from central government • PCTs – Commissioning of services – Provision of services – Public Health role 2
3 Where is Salford?
Salford • 230,000 population • A post industrial city • 35% of ward areas are in the 10% most deprived in the country • PCT co-terminous with local government 4
Salford – Male Life Expectancy 78 77 76 75 74 Years 73 72 71 70 69 68 1995/96 2002-04 2003-05 2004-06 Salford England 5
Salford – Female Life Expectancy 82 81 80 79 Years 78 77 76 75 1995/96 2002-04 2003-05 2004-06 Salford England 6
Salford – A Few Health Statistics Standardised Mortality Ratios (SMRs) • Heart Disease & stroke in under 65s – 151 • Stroke – 137 • Cancers – Colon – 126 – Lung – 180 – Oesophagus – 153 – Stomach – 132 • Anti-depressants 1/3 above national average 7
Primary Care in Salford • 53 GP Practices • 155 doctors • Practices – Separate organisations – Partnerships or sole traders • Contractual relationship with the PCT as commissioner 8
Features of the GMS Contract • Core contract based on population size • Performance based component – 3 domains • Clinical • Organisational • Patient experience • Specific funding for additional services – National – Local 9
Quality & Outcomes Framework (QOF) Clinical Indicators Palliative care Secondary prevention of coronary heart disease Mental health Cardiovascular disease – primary prevention Asthma Heart failure Dementia Stroke and Transient Ischaemic Attack Depression Hypertension Chronic kidney disease Diabetes mellitus Atrial fibrillation Chronic obstructive pulmonary disease Obesity Epilepsy Learning disabilities Hypothyroid Smoking Cancer 10
Quality & Outcomes Framework (QOF) clinical domain examples • Percentage of patients with coronary heart disease in whom the last blood pressure reading is 150/90 or less • Percentage of patients with coronary heart disease whose last measured total cholesterol is 5mm/l or less • Percentage of patients with hypertension in whom the last blood pressure reading is 150/90 or less • Percentage of patients with diabetes in whom the last blood pressure reading is 145/85 or less • Percentage of patients with diabetes in whom the last HbA1c is 7.5 or less 11
Quality & Outcomes Framework (QOF) Organisational Domain • Records and information • Information for patients • Education and training • Practice management • Medicines management 12
Quality & Outcomes Framework (QOF) Patient Experience Domain • Length of Consultation • Access to a Primary Care Professional within 24 hours • Access to a GP within 48 hours 13
Analysis of GP Practice Size in Salford 14 12 10 Frequency 8 6 4 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 4 5 6 7 8 9 0 1 2 3 4 1 1 1 1 1 1 - - - - - - - - - - - - - - 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 3 4 5 6 7 8 0 0 0 0 0 9 0 1 2 3 1 1 1 1 Number of Patients 14
15 9 8 7 Number of GPs within Each Practice 6 GPs 5 4 3 2 1 20 18 16 14 12 10 8 6 4 2 0 Frequency
List Size (Number of Patients Per GP) 10 9 8 7 Frequency 6 5 4 3 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 5 0 5 0 5 0 5 0 5 0 5 0 2 5 7 0 2 5 7 0 2 5 7 0 2 5 1 1 1 2 2 2 2 3 3 3 1 - - - 0 0 - - - - - - - - - - 0 - 5 0 0 0 0 0 0 0 0 0 0 0 0 2 5 5 0 5 0 5 0 5 0 5 0 5 0 2 5 7 0 2 5 7 0 2 7 1 1 1 1 2 2 2 2 3 3 Patient Numbers 16
Frequency 10 0 1 2 3 4 5 6 7 8 9 0 - 250 250 - 500 500 - 750 List Size (Number of Patients Per GP) 750 - 1000 1000 - 1250 Patient Numbers 1250 - 1500 1500 - 1750 1750 - 2000 2000 - 2250 2250 - 2500 2500 - 2750 2750 - 3000 3000 - 3250 3250 - 3500 Single GP > 1 GP 17
QoF Points – Performance of Salford GPs Maximum Available Points % Points Points Achieved Achieved Domain 2008/09 2008/09 2008/09 Clinical 36,400 32,883 90.34% Organisational 9,380 7,785 82.99% Additional services 2,016 1,724 85.53% Patient experience 8,204 6259 76.29% Total 56,000 46,242 82.58% 18
Achievement 100% 10% 20% 30% 40% 50% 60% 70% 80% 90% 0% Locum To Dr Chowdhury(Jeet II) Gore H Leach G Davis Ws Borg-Costanzi Jm % of patients with Coronary Heart Disease whose last measured total cholesterol (measured in the previous 15 months) is 5 mmol/l or less. Larah Dg Sinha Rp Levenson S Rolfe Jn Drs Nagesh & Chilamkurthi Tauk T Sultan M Salim A Rahman A Element P Boyce Ct Salford Care Centres Weaste Finegan Na Buch Kh Singh Hs Coronary Heart Disease 8 2008/09 Warburton Salford Health Matters Ahuja A Browne Nb Practice Name Mccorkindale S Average Achievement % Actual prevalence % Achieved % Not Achieved % Exceptions Collier Jeet I Lindsay Sd Yates Ms Tamkin Ej Sharma Mm Malcomson Ci Kassam Nn Singh H Haber S Khan Mt Dr Amin Kyaw T Hope B Dr Loomba Joshi V Marginson Je Dr Budden Randall Sc Tankel Jw Stedman Hgb Koria K Tyrrell Nm Allweis B Ghosh Pr Saxby K 19 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00% 8.00% 9.00% 10.00% Prevalence
Achievement 100% 10% 20% 30% 40% 50% 60% 70% 80% 90% 0% Salim A Gore H Drs Nagesh & Chilamkurthi Sultan M Leach G Borg-Costanzi Jm Tauk T Davis Ws Larah Dg Salford Care Centres Weaste Dr Loomba Jeet I Haber S Levenson S % of patients with Diabetes in whom the last blood pressure was 145/85 or less Boyce Ct Locum To Dr Chowdhury(Jeet II) Dr Amin Collier Tankel Jw Salford Health Matters Tamkin Ej Diabetes Mellitus 12 2008/09 Joshi V Rolfe Jn Singh Hs Practice Name Malcomson Ci Average Achievement % Actual prevalence % Achieved % Not Achieved % Exceptions Marginson Je Randall Sc Element P Browne Nb Rahman A Warburton Ghosh Pr Koria K Stedman Hgb Finegan Na Sharma Mm Kassam Nn Sinha Rp Singh H Buch Kh Saxby K Mccorkindale S Hope B Kyaw T Khan Mt Tyrrell Nm Ahuja A Allweis B Lindsay Sd Dr Budden Yates Ms 20 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00% 8.00% 9.00% 10.00% Prevalence
Salford PCT - Practice Points Achievement 2008/09 PATIENT EXPERIENCE PATIENT EXPERIENCE ADDITIONAL SERVICES ADDITIONAL SERVICES ORGANISATIONAL CLINICAL 1000 800 Total Points 600 400 200 0 n A t T I K A T G S p b s M n h a H r c V P e B B g n s K i j b S s n m n a t w d A m S r H m C s E e y i e t C M P R i N W J K N S J D o M H e N b S h r k e g J r w n m m e i i t s e a t r M y a n N h h n J e s d u e t e l h n t n H e m h e r l l u e n i p i n b n j r c o a e h n t h r s h m l y u a l a g A s a i i c o l s e r i a b d h l u f o t a e J u o a e a s a s h n c l a z a o o a e o k g a o x a m l y n i t l a y C o a w e n u d h G T m b a a k e d k o e n r v l o u g n d s H r s m m o a h s K n w u S o M t K W a n A i D J a H B s n w h r n m h S a R a n n l a r m S K d L e i B e e l m i L r o S B a a r s a a S D t A L Y S o y i G v n a l i a n k a s h g W o T s r E d a r T R T e i R h h i r l B o t c e D F r K L i L l e C o h a l r S C a a t t c M C e n S - M r c g H D e M & r C o d o h B r T e o s r m e f a l g a C u S a c d N o r s o L f r l D a 21 S All single GP practices Practice Name
Enhanced Services � Learning Disabilities � Anti-Coagulation Services � HPV Vaccination � Drugs � Childhood Vaccination & � Active Case Management Immunisations � Near Patient Testing � Safe Haven Service � Access/Extended Hours � Influenza & Pneumococcal � Heart Failure Services Immunisations � Homeless Services � Alcohol Tier 1 (DES) � Minor Surgery � Alcohol Tier 2 (LES) � Osteoporosis � Gateway Programme � Cardio-Vascular Disease � Ethnicity � Smoking � Health Inequalities � intrauterine contraceptive device (IUCD) � Practice Based Commissioning Insertion � Choice & Booking � IM&T 22
Other Contractual Arrangements • Personal Medical Services Contracts (PMS) – Locally negotiated – Based on GMS Contract • Equitable Access – Tendered Contract, open to competition – 3 – 5 year contracts 23
The GMS Contract – Key Points To Reflect On • Based on need • Clinical good practice incentives • Flexibility in the way it can be delivered • Encourages larger group practices • Local tailoring via LESs 24
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