Creating the capacity to meet patient need is a key issue for primary care

1. Workload Analysis Tooldeveloped byThe Working in Partnership ProgrammeJanet BellNewham Local EMIS User Group11 December 2008

2. Improve patient access Positive patient experience Create capacity World Class Commissioning Develop the workforce Creating the capacity to meet patient need is a key issue for primary care Data

3. The Workload Analysis Tool provides the evidence to prompt changes that improve services to patients and increase capacity • Provides the evidence needed to plan changes • Identifies real time workload demands • Locally led • Measures and monitors improvements • World class commissioning

4. Today • The project and its origins • How the tool works • Case studies and benefits realised • Potential use • Status and future aim

5. WiPP’s aim is to inspire change • The Working in Partnership Programme • £10m investment in general practice • drive and support efficiency and effectiveness • Improve access • Create capacity • Maintain quality • Strong partnership and governance structure

6. Information to support decisions vital

7. The Tool works by extracting Read code data & presenting it back to practices as information • Reports run automatically each month in each practice • Reports clinical Read code activity in 3 workbooks A Total Read code count in the top 10 chapters B Breakdown by professional category and individual C Breakdown by age and sex • During pilot phase tool is compatible with majority of clinical systems • One consultation may have multiple Read codes • provides relative clinical activity

8. Example C….. Endocrine/immune disease C1… Other endocrine gland diseases C10.. Diabetes Mellitus C108. Insulin dependent diabetes mellitus C1080 Insulin dependent diabetes mellitus with renal complications Recording consultations – Read codes • The clinical classification system • Hierarchical structure • Codes are divided up into chapters • Workload Analysis Tool extracts Read codes entered during a consultation

9. 1400 1171 1200 979 1000 800 600 400 310 204 186 167 158 200 155 154 131 121 121 99 87 81 66 62 44 24 18 7 6 5 2 1 0 B.... Neoplasms E Mental disorders S Injury and poisoning Q Perinatal conditions P Congenital anomalies 3 Diagnostic procedures 6 Preventive procedures Z Unspecified conditions J Digestive system diseases A Infectious/parasitic diseases G Circulatory system diseases 8 Other therapeutic procedures H Respiratory system diseases 7 Operations, procedures, sites 5 Radiology/physics in medicine U [X]Extern caus morbid/mortal T Causes of injury and poisoning K Genitourinary system diseases N Musculoskelet/connectiv tissue D Blood/blood forming organs dis M Skin/subcutaneous tissu diseas L Pregnancy/childbrth/puerperium F Nervous system/sense organ dis C Endocr/nutr/metab/immun.diseas R [D]Symptoms,signs,ill-def.cond Example – Total Read codes count for 1 practice Read code recording rates by chapter heading (excluding History/Examination, Administration and Laboratory Procedures)

10. 60 55 50 46 40 29 30 25 20 12 12 12 11 11 9 8 10 7 7 6 5 5 5 4 4 4 0 N143. Sciatica N245. Pain in limb N06z. Arthropathy NOS N05z. Osteoarthritis NOS N040. Rheumatoid arthritis N142. Pain in lumbar spine N094. Pain in joint - arthralgia N145. Backache, unspecified N20.. Polymyalgia rheumatica N131. Cervicalgia - pain in neck N220. Synovitis and tenosynovitis N224. Ganglion and synovial cyst N217. Enthesopathy of ankle/tarsus N213. Enthesopathy of elbow region N050. Generalised osteoarthritis-OA N33z. Bone/cartilage disord. OS/NOS N110. Cervical spond.-no myelopathy N210. Adhesive capsulitis - shoulder N211. Rotator cuff shoulder syndrome N247. Other musculoskel.limb sympts. Example - Musculoskeletal (Chapter N)

11. Example – Top 10 breakdown by all clinician types

12. Example – Breakdown by professional

13. Top 15 Read codes recorded in Females & Males (age 45-64 yrs) 300 252 248 250 200 150 118 109 90 89 100 78 78 73 72 68 66 63 58 51 50 46 42 41 41 39 37 36 50 33 33 31 31 28 24 23 0 Female N245. Pain in limb Male 6799. Health ed. - diet Male HNG0600 [RFC] Cancer Male 65E. Flu vaccine given Male 138.. Exercise Grading Male 22K.. Body mass index Female 6799. Health ed. - diet Female 22K.. Body mass index Male 136.. Alcohol consumption Male 6798. Health ed. - exercise Male 388.. Miscellaneous scales Male 137.. Tobacco consumption Male G20.. Essential hypertension Female 136.. Alcohol consumption Female 137.. Tobacco consumption Female 388.. Miscellaneous scales Male 9D11. MED3 issued to patient Female G20.. Essential hypertension Female N094. Pain in joint - arthralgia Female 9D11. MED3 issued to patient Male 8CAL. Smoking cessation advice Female E2B.. Depressive disorder NEC Male 246.. O/E - blood pressure reading Female 8CAL. Smoking cessation advice Male 8B3x. Medication review with patient Male H06z. Acute bronchitis/bronchiol.NOS Female 7G2A. Intr therap subst subcut tiss Female 8B3x. Medication review with patient Female H06z. Acute bronchitis/bronchiol.NOS Example – Breakdown by age and sex Female 246.. O/E - blood pressure reading

14. The Reports have delivered benefit in a number of key areas PBC Workforce planning Data Quality Service development Training Workload distribution Self care Benchmarking

15. Case Study 1: Practice To increase capacity within the nursing team Identified workload areas for nursing team Two tasks currently carried out by the Practice Nurses could, with training, be done by HCAs;(i) assessment of foot pulses in diabetic patients(ii) first-line intervention in smoking cessation The Challenge Role of the WAT The Solution

16. The WAT is making a real difference The Result • Developed the role of the HCA • - Two HCAs trained in foot pulse assessment • Freed practice nurse appointments • - 5.3 hours from the practice nurse appointments • - 23 hours per month • Implemented new pathway • - HCAs first-line intervention for smoking cessation

17. The Challenge Case Study 2: Commissioning A proactive approach to managing demand for musculoskeletal services More efficient and effective services across the PCT Access to detailed and accurate data identifying the extent of the workload by individual clinicians Planning for new services based on patient demographics Full musculoskeletal pathway review Role of the WAT The Solution

18. The Challenge Case Study 3: Stratford Village Surgery Experience Too many practice objectives Changing NHS Issues related to workload within the practices Outside agency involvement Identified need for read code training and data validation Positive feed back to team Monitored improvement Identified high musculo-skeletal referral rate Standardised data entry Identified areas for focus Commissioned new physiotherapy service Cost saving Role of the WAT The Solution Pranoti Shah IT/Data Performance & Quality Manager Stratford Village Surgery

19. The Challenge Case Study 4: The Newham Health Partnership Experience NHS access targets Population demand Health inequalities Focus on quality of data Positive feed back to teams Identifies areas for change Monitor changes A proactive approach to improving local services Managing the demand Commissioning new services based on accurate data Potential cost saving Role of the WAT The Solution

20. Newham HP amalgamated data

21. Newham HP – recording of DNA codes

22. Code entry - percentages by GPs and staff 80% % age by GPs % by practice nurses % by Nurse prac 70% % by HCA % by other staff 60% % of by comm staff 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Benchmarking – data input by clinicians

23. Benchmarking – comparison of data entry by practice size

24. Benchmarking – variation in respiratory code entry

25. Benchmarking – BPs variation by practice and by input by staff

26. Summary of key benefits • Drives data quality • Practical lever to drive local data quality • Improves skill mix • Matching patient need to the right health care professional • Information to support service redesign decisions • Evidence to inform the right change to meet local need • Creates capacity • Identifies opportunities to improve patient access

27. Going forward the WAT has wider potential use National Audits Commissioner Tool Standardised Data Quality Practice Accreditation Programme Budgeting Linked with other data

28. Workload Analysis Tooldeveloped byThe Working in Partnership ProgrammeJanet Bellwipp@healthcomm.org.uk