Understanding our local population Matt Gummerson, Strategic Lead for Intelligence, Public Health www.portsmouth.gov.uk
Overview 1. Public Health Portsmouth 2. What is population health? 3. Why is it important for PCNs? 4. Tools 5. PCN profiles / data packs www.portsmouth.gov.uk 2
Public Health Portsmouth Public Health moved into the local authority in 2013 Director of Public Health, Consultants + Health Development Managers/Commissioners, Trainees, Intelligence. Responsible for: • Commissioning health services • Embedding health in local plans • Providing public health expertise health commissioners and council services Wellbeing Service: smoking cessation, alcohol, weight management www.portsmouth.gov.uk 3
What is Population Health Management? Population Health… Population Health Management … …is an approach aimed at improving the …improves population health by data health of an entire population driven planning and delivery of proactive care to achieve maximum impact It is about improving the physical and mental health outcomes and wellbeing of people, whilst reducing health inequalities It includes segmentation, stratification and impactability modelling to identify local ‘at within and across a defined population. risk’ cohorts – and, in turn, designing and targeting interventions to prevent ill-health It includes action to reduce the occurrence and to improve care and support for of ill-health, including addressing wider people with ongoing health conditions and determinants of health, and requires reducing unwarranted variations in working with communities and partner outcomes agencies www.portsmouth.gov.uk 4
Focus on the wider determinants of health to make the biggest impact www.portsmouth.gov.uk 5
Risk Stratification: segmenting according to risk of service use www.portsmouth.gov.uk
Population Health and Integrated Care • PHM enables systems and local teams to understand and look for the best solutions to people’s needs – not just medically but also socially – including Primary Care the wider determinants of people’s Networks health. Population Personalised Health • Care Many people need support with issues Management such as housing, employment, or social isolation – all of which can affect their physical and mental health – these solutions are often already Care tailored available through, or better designed to personal with, local people, the local council or needs and a voluntary organisation. delivered • Better partnership working using PHM close to home to join up the right person with the right care solution helps us to improve outcomes, reduce duplication and use our resources more effectively www.portsmouth.gov.uk 7
Why now? Long Term Plan ICSs will cover all of the country making shared decisions with providers on how to use resources, design services and improve population health. Each ICS will be required to implement integral services that prevent avoidable hospitalisation and tackle the wider determinants of mental and physical ill-health Primary care networks will from 2020/21 assess their local population by risk of unwarranted health outcomes and working with local community services make support available to people where it is most needed …..using a proactive population health approaches to enable earlier detection and intervention to treat undiagnosed disorders. GP Contract 5 year Framework Through their Integrated Care Systems, NHS England will also ensure that predictive analytical tools are available to Primary Care Networks. These will help them identify those groups of people who are most at risk of adverse health outcomes and increasingly predict which individuals are most likely to benefit from different health and care interventions . This is an important enabler for the new Anticipatory Care requirem ents www.portsmouth.gov.uk 8
Tools - fingertips.phe.org.uk www.portsmouth.gov.uk 9
Tools - GP practice profiles www.portsmouth.gov.uk 10
Index of Multiple Deprivation 2019 - Ranking of small areas (c.1,500 people) on deprivation relative to rest of England - Association between deprivation and poor health www.portsmouth.gov.uk 11
More tools… Other PCN profiles by combining data on Fingertips from each practice – are these useful? Other tools: • SHAPE: Strategic Health Asset Planning and Evaluation • Local Health • Atlas of Variation • NHS RightCare – PCN packs coming soon www.portsmouth.gov.uk 12
www.portsmouth.gov.uk 13
PCN Profiles / Data Packs The purpose of the packs is to support: • PCNs to understand their local populations from a demographic, public health, clinical and outcomes perspective • Clusters to use population intelligence to inform decisions on the planning and delivery of care • Clusters to identify specific areas of need within their population that will be prioritised for future work Next steps - use the packs to: • Deepen understanding of PCN populations • Determine areas for further analysis – e.g. by combining intelligence from primary care clinical systems / public sources / discussing with your CCG • Determine areas for intervention e.g. quality improvement programmes / joint pathways of care / awareness raising • Other needs assessments where may be able to provide additional information? www.portsmouth.gov.uk 14
Break out sessions Opportunity for you to discuss with others in your PCN: • How you will use a population health approach • What your PCN profile tells you about priorities for your PCN • How you want to use these packs in the future • What else you might need to effectively apply population health approaches locally www.portsmouth.gov.uk 15
Any questions? Matt Gummerson Strategic Lead for Intelligence Matthew.Gummerson@portsmouthcc.gov.uk 023 9284 1420 www.portsmouth.gov.uk 16
Recommend
More recommend
