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NEW Service

NEW Service. Central Cheshire PCT Dr Bill Forsyth. A Bit of History…. Once upon a time in a galaxy far, far away…… Historical Accident of GP OOH Cover On Call as it used to be……… Change of Landscape Shared Rotas Co-operatives New GP contract. Consistent Themes. Fear of Change

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NEW Service

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  1. NEW Service Central Cheshire PCT Dr Bill Forsyth

  2. A Bit of History…... • Once upon a time in a galaxy far, far away…… • Historical Accident of GP OOH Cover • On Call as it used to be……… • Change of Landscape • Shared Rotas • Co-operatives • New GP contract

  3. Consistent Themes • Fear of Change • ‘What if you get busy?’ • ‘I don’t want him looking after my patients’ • ‘It’ll never work’ • ‘Our system can’t be improved on’ • Rapid normalisation/acceptance of new systems • Demarcation disputes - esp A&E • Lack of whole system approach

  4. Current Position in Central Cheshire • Population 250,000; 30 practices • 5 different sets of arrangements across PCT • 3 different Co-ops within PCT • 3 practices on boundaries with other PCT Co-ops • Concerns around Deputising Service used by 2 Co-ops

  5. Blocks in Old System • Insular, GP-dominated • ‘Can’t be improved on’ • Lack of strategy/development • Poor IT use • Reluctance to work with A&E, other agencies • Lack of equity across PCT

  6. Initial Survey Results • Indicated 100% GP opt-out • Indicated number of GPs willing to do some OOH work • Some times less popular than others • No surprises!

  7. Options • Status Quo - not viable • Existing Co-ops flexing to cover whole PCT - unwillingness to do so; high costs for same service covering same areas • Use of Deputising Service - quality concerns/cost • PCT run service

  8. PCT Approach • One element of GMS Implementation Plan • Linked to Emergency Care Network • Collation of Data on activity • Finance - available resources and costs • Group to oversee - appropriate Membership • Underpinning work-streams • Outline proposals for comment/revision • Process of continuing refinement of plans

  9. Outline Plan • NOT ‘more of the same’ • NOT just a GP service • April 2004 start • Single PCT run service • Central Triage - robust, good quality • 2 main PCCs - VIN and Leighton Hospitals • Co-location/Integration with MIUs

  10. Outline Plan • Service tailored to match demand • Service worked up in partnership with MCHT, MRAS, PT, SS • Involving other disciplines - paramedics, SS, NPs, DNs, etc. - skillmix • Evolving service - initially heavily GP-led • Gradual ‘growing’ of other staff • Close monitoring of demand, problems, etc. with appropriate adjustment to service

  11. Critical Planning Elements • Rotas • Recruitment - practices, GPs, salaried GPs, NPs, other staff • Finance • Not enough money in the system • ‘In generous baseline’ as usual • No option but to fund gap

  12. Other Key Elements • Will and Commitment • Communication, communication, communication • Public Consultation • Clinical expertise and input • Recruitment • Management and Organisational support • Pharmacy Minor Illness and Rep Rx Schemes • Shared working with neighbouring PCTs

  13. Shared PCT Working • Other Cheshire PCTs • Adastra/Technical Links Programme • Sharing best practice • Cross-boundary issues

  14. The Future? • Evolving Service • Management Board to oversee service delivery/quality, shape and develop service • Appropriate membership critical • PCT commitment • Strategy/Innovation • Integration with A&E/MIU • Staff Training and Development

  15. Opportunities in PCT Run Service • Ability to cope with Financial Risks • HR/Finance/Management Support • Removal of vested interest/demarcation disputes • Leverage to broker whole system change • Shared working • Easier to realise A&E/Minor Injuries, Ambulance Service benefits • Other organisations

  16. ‘Mutual’ organisations • Some of ideas seductive • Should NHS be more like this? • Disparaging of PCT ability to provide service • Distrust/fear of PCTs • Could be described as ‘more of the same’ or attempt to preserve status quo • ‘Independence’ - good or bad thing?

  17. From PCT Perspective • Complicated/complex • Introduces another organisation • PCT remains responsible anyhow • Alternative is simplicity and control • Will this deliver integrated, whole-system working? • Lack PCT resources - ?long-term viability • Balancing risks and benefits

  18. Way Forward? • Understand wide variations in Co-op and PCT maturity/skills/attitudes • Need to build relationships/trust • Many similar strands to proposals • Objectives should be the same • Likely to be variety of solutions • Does it matter as long as deliver?

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