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Facilitation in the London Cluster

PRIMIS. Facilitation in the London Cluster. Susan Wilson (Richmond & Twickenham PCT) Mark Worboys (Kingston PCT). Fifth Annual Conference 11 – 12 May 2005 Pieci ng Together the Future. Facilitating in Kingston and Richmond Care Community. Presented by:

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Facilitation in the London Cluster

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  1. PRIMIS Facilitation in the London Cluster Susan Wilson (Richmond & Twickenham PCT) Mark Worboys (Kingston PCT) Fifth Annual Conference 11 – 12 May 2005 Piecing Together the Future

  2. Facilitating in Kingston and Richmond Care Community Presented by: Susan Wilson – Richmond & Twickenham PCT Mark Worboys – Kingston PCT Date 11th May 2005

  3. Introductions • Susan Wilson, Primary Care Information Manager, Richmond & Twickenham PCT • Mark Worboys, Programme Manager, Kingston PCT

  4. What do you call a project…? • That has had rotten publicity • Is very political • Has shifting targets • Changed its name and agenda • Is dependant on multiple external contractors • ?? !! ??

  5. The project- Background and demographics- Targets- The care community- Achievements- Challenges- Roll-out and strands- What helped?- June to October

  6. Background & Demographics, Richmond 190,000 population History of boundary changes, now co-terminous with its London Borough Well off and healthy on the whole, suburban GPs mainly refer to KHT, West Midd, Queen Mary’s 31 practices, most small to medium sized, 5 with branches 21 IPS, 8 EMIS, 2 Torex Community services Teddington Memorial Hospital + WIC GPsWSI clinics

  7. Background & Demographics, Kingston 170,000 population Well off and healthy on the whole, suburban Mainly refer to Kingston Hospital, with some to Epsom St Helier and St George’s 29 practices - small number with single branches Mixed 13 IPS, 3 Alt-GP, 3 EMIS, 10 Torex Community services Tolworth and Surbiton Hospitals GPsWSI clinics

  8. The targets - history: • Initial targets • focus on full booking target • distracted from chooseandbook roll-out • Change of emphasis DoH Dec 2004 • NAO January 2005

  9. The targets - now • June 2005 • 4/5 providers – ie choice • 30% of GPs • 100% DoS • October 2005 – 50% of all referrals • December 2005 CPOR and 80% referrals • December 2006 90% of all referrals

  10. What we’ve achieved • When we wrote this: • 10 practices live • 2 specialties • 3 bookings • Nearly 50 GP out of 220+ • Latest news…

  11. Challenges • Finding the time ourselves • Engaging the GPs • Engaging the PCT • Jostling with AfC, PBC, nGMS, enhanced services, star ratings, LDP ………

  12. More challenges • Understanding the issues • Understanding the software (before we’ve seen it) • Working out what had to be done • Multi-stranded • Keeping up with the pace • All that reporting!

  13. And more challenges… • GDPs • Mental Health • GPsWSI • Primary to primary referrals • QMH turns out to be a Primary care provider

  14. How we did it - 1 • Board level commitment • Planning and organisation • People dedicated to the project • Practice rollout programme • Smart cards & RA • Hospital systems • Hardware & software rollout to practices

  15. How we did it - 2 • Engaging providers • PCT as provider • N3 • Clinical systems upgrades • Training and making chooseandbook work for practices • Communications

  16. Rollout • Organisation workshop May 2004 • Project planning workshop June 2004 • Pilots or big bang? Practices or hosp specialties? • Consensus and agreement • Collaboration • Think team!

  17. Practice rollout • Sept – set up programme of 5-6 practices per month between March 2005 to Sept 2005 • Finger in air • Tricky practices to end – risk management • Agreed with PMs • Adaptable – have moved practices around • Engagement and launch events

  18. Smart Cards & RA • Difficult to get a grip • Availability of robust kit • Staff left; catch up in process • User friendly manual • Ongoing management - HR • Technical hitches • Time consuming • No, you can’t share your smart card!

  19. Practice IT • Inventory drawn up early on • Dedicated time of IT person – took about a month • Purchasing programme • Using incentive £ to fund • We reckon 3/4 yrs upgrades squeezed into one • Additional resource to do roll-out - faster • Test referral for sign-off

  20. Providers & choice - RTPCT • Refer to 3 main providers • Many others on borders (Charing Cross, Chelsea-Westminster, Ashford St Peter’s, St George’s • So choice itself not a problem for us • BUT - how will this affect our current pattern of referrals?

  21. Providers & choice - KPCT • 9 out of 10 to KHT • Meet booking targets • But, not much choice! • Others – ESH and STG • Impact on current pattern of referrals? • Working with practices to map provision

  22. PCT as provider • Primary care based clinics to DoS • R&T clinics at TMH go onto DoS of host Trusts showing separate location • Discussed clear descriptions with their DoS writers • KPCT still clarifying position

  23. N3 • Time & effort in applying for upgraded lines • Plan to verify lines are upgraded • Branches • Firewall version upgrade next • Deal with exceptions as they arise

  24. Clinical system upgrades • Web-based booking to start • Aware suppliers developing software • Working closely with IPS • About to start with EMIS • Torex to follow

  25. Training • Effort and planning • Training room booked in advance ! • Dedicated trainer • 4 sessions per week into September • Follow up in practices (facilitators) • Use of web based training tool • And national demo system for ourselves • Superusers

  26. What helped - 1 • Board level support and commitment • Support / commitment of NPfIT • ATOS on team • Problem solving – don’t wait for someone else to fix it

  27. What helped - 2 • Dedicated people – IT, project manager, trainer, admin support • KRCC Project Manager got us started • Constantly talking to each other • Regular informal meetings • Gradual understanding from practices, once saw software

  28. What helped - 3 • Growing interest from GPs – cultivate • Engagement/communications - all • Regular slot at practice managers’ meetings • Former practice manager on team • Website leaflets • Earlyish start

  29. What helped - 4 • Practice managers on the Project Board • Monthly project board • Highlight reports • Issues and risk database • Risk management strategy • Scheduled team meetings • Repeated visits to practices

  30. June to October • Executive leads • Performance management • Indirect booking • All providers • Working with the practices • Incentive schemes • Patient/public involvement

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