West & North Midlands Midlands & East Region GP Online - PowerPoint PPT Presentation

West & North Midlands Midlands & East Region GP Online Consultation Project Workshop GP Online Consultation Project Workshop 4 th May 2018 Jury’s Inn, Broad Street, Birmingham B1 2HQ www.england.nhs.uk

Agenda 10:00 Arrival, Networking and Coffee 10:30 Welcome and introductions – Fiona Sanders 10:35 A Digital Vision for Primary Care – Dr Ruth Chambers 10:50 Challenges and Benefits of GP Online Consultation – Dr Clive Prince 11:05 11:05 Change Management Challenge - Key issues - NHSD Transformation & Change Team – Sean Fearn Change Management Challenge - Key issues - NHSD Transformation & Change Team – Sean Fearn 11:15 Presentations from areas: Project implementation, common issues and lessons learned West DCO Team - Ciaron Hoye, Ravy Gabrria-Nivas & Ash Vora (Birmingham & Solihull CCGs) West DCO Team - Lynda Dando & Alan Luckman (Worcestershire CCGs) North DCO Team - Andy Hadley (Staffordshire CCGs) 12:15 Tea/Coffee Break and Networking 12:30 Interactive session - Key challenges 13:15 Questions and Next Steps: GP Online Consultation DCO HoDT / Project Managers 13:30 Close www.england.nhs.uk 2

Welcome and Introductions Introductions Fiona Sanders www.england.nhs.uk

The Digital Vision for Primary Care Dr Ruth Chambers OBE GP, Clinical lead for TECS Staffordshire STP digital workstream, Chair Stoke-on- Trent CCG www.england.nhs.uk

The Digital Vision for Primary Care The Digital Vision for Primary Care Dr Ruth Chambers OBE, GP, Clinical lead for TECS Staffordshire STP digital workstream, Chair Stoke-on-Trent CCG www.england.nhs.uk

Digital Vision www.england.nhs.uk 6

GP Forward View www.england.nhs.uk 7

Collaboration around a defined LTC priority – new ways of delivery (e.g. skype consultations) Clinical team Minimise duplication – Patient –self care shared care plan Innovation LTC pathway Evidence base Workforce training/ upskilling Data and Technology measurement www.england.nhs.uk 8

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Cardiovascular Disease Prevention Pathway – Risk Detection and Secondary Prevention in Primary Care Cross Cutting: 1. NHS Health Check - systematic detection of high BP, AF, NDH, T2DM, CKD, high cholesterol, CVD risk Variation: 2. System level action to support guideline implementation by clinicians inter- 3. Support for patient activation, individual behaviour change and self management practice and inter-CCG High BP detection AF detection and Type 2 Diabetes CKD detection and Detection, CVD risk Diabetes detection and treatment anticoagulation assessment, treatment preventive intervention and treatment management measures and support CHD haviour change 85% of FH undiagnosed & 5 million undiagnosed. 400k undiagnosed. 1.2m undiagnosed. 5 million un- 30% undiagnosed. The diagnosed. 40% Over half untreated most people at high CVD Most do not receive 40% do not receive Many have poor BP & Opportunities poorly controlled or poorly controlled risk do not receive statins intervention all 8 care processes proteinuria control Stroke Heart Population me for beh Failure Failure Intensive bhviour change Management of CVD BP lowering Anticoagulation Behaviour change and Control of BP, HbA1c The Evidence prevents strokes prevents 2/3 of statins reduce life time (eg NHS DPP) reduces and lipids improves risk, BP & proteinuria T2DM risk 30-60% improves outcomes and heart attacks strokes in AF risk of CVD CVD outcomes PAD The Risk Blood Atrial High CVD risk & NDH Type 1 and 2 Chronic Kidney Condition Pressure Disease Fibrillation Familial H/cholesterol (‘pre-diabetes’) Diabetes Primary Established Detection and Secondary and Tertiary Prevention Disease Prevention 50% of all 5-fold increase Marked increase in Marked increase Marked Marked The Outcomes strokes & heart in strokes, premature death in increase heart Increase CVD, attacks, plus often of and disability from Type 2 DM and attack, stroke, acute kidney CKD & greater CVD CVD kidney, eye, injury & renal dementia severity at an earlier age nerve damage replacement

Shared decision making Advanced High communication skills with data on options, outcomes, evidence and risk Clinician resources resources LTC management and prevention Low High Low Patient resources Surgical Medication Behaviour Type of LTC Acute life decisions compliance management change decision threatening www.england.nhs.uk 11

Universal Capabilities – Patient Online Services 1. Patients can access their GP record • “ better informed patients ” (GP) • “ elderly patients prefer to talk to someone ” (GP) 2. Patients can book GP appointments and order repeat prescriptions • “ reduced workload as more prescriptions requested electronically ” (GP) • “ need to be computer literate to benefit from PO ” (practice manager - PM) • “ cannot book appointments with nurses ” (PM) www.england.nhs.uk 12

Online consultations? Patient’s /clinician’s willingness- perception, choice and personal views about usefulness & outcomes, costs, availability, personal identity, accountability and governance? Ready for change? www.england.nhs.uk

Making the digital vision happen Aim – Adopt Outcomes – Improve technology patient /clinical management of long enabled care as usual practice term conditions/adverse lifestyle habits - lifestyle habits - efficiently Resources – Who/what Scope – Which type(s) do you need – of technology will you equipment, use to achieve planned competence, practice outcomes/ what LTCs support, online clinical will you focus on? consultation triage? www.england.nhs.uk

Online Consultation – Challenges & Benefits Challenges & Benefits Dr Clive Prince FRCGP Digital Clinical Champion – Digital Transformation of Primary Care, NHS England RCGP Person Centred Care Network of Champions May 2018 www.england.nhs.uk

“Patients and information are the information are the two most under-used resources in the NHS” Dr Richard Fitton Cartoon with thanks to the British Medical Journal www.england.nhs.uk

Digital Primary Care is NOT 1. For everyone • Patient Online experience; surprisingly – disabled etc 2. Extra workload • Primary Care hasn’t capacity 3. Squeezing in extra appointments www.england.nhs.uk

The Reality: www.england.nhs.uk 18

80% Sending/receiving emails (79%) 70% Finding information about goods and services (76%) 60% Social networking (eg Facebook or Twitter) (63%) 50% Reading online news, newspapers or magazines (60%) 40% Internet banking (60%) 30% 30% Looking for health-related information (eg injury, disease, 20% nutrition, improving health etc) (51%) Using services related to travel or travel related accommodation 10% (51%) Making an appointment with a doctor or other healthcare 0% practitioner via a website (15%) 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Internet activities in the past three months http://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetandsocialmediausage/bulletins/internet accesshouseholdsandindividuals/2016

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Pressures on General Practice Population Relative funding Consultations Consultations Relative workforce Relative workforce Complexity Costs www.england.nhs.uk

GPs judged 26% of their consultations Other in practice to be potentially 7% avoidable Self care/Pharmacy 6% Potentially Data from Data from avoidable GP avoidable GP 4% 4% Outpatients Outpatients 74% appointments 5,128 3% (audit by GPs) consultations Sick notes / appeals 3% 2% Care navigation 2% Continuity/preparation … 18% are about Other how the practice manages its bit.ly/time4caretool1 workload www.england.nhs.uk