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Alternative Quality & Outcomes Frameworks in PMS

Redesign of Care Pathways For Dermatology and Orthopaedics

21 out of 22 practices have formed a consortium in West Norfolk and have been involved in the redesign of care pathways for dermatology and orthopaedics, which come into effect on 1 February 2006.

Attention is now being turned to the redesign of radiology services.

For further information please email; This e-mail address is being protected from spambots. You need JavaScript enabled to view it or telephone Noel McGivern on 01563 819460.
 

Case Studies to Support Practice Based Commissioning

Community Diabetes Services
Practice In Lambeth PCT

South Lambeth Road Practice (for further details contact Victoria Churchill on 020 2622 1923 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it ) has developed a community diabetes services using PMS as a contracting tool.

The practice has a GP who has been a clinical assistant in diabetes for many years at the local NHS Trust.  Through PMS the practice has contracted with its PCT (Lambeth) to deliver a community diabetes service for its own practice population and that of neighbouring practices in Stockwell.  The practice has negotiated with the PCT a baseline figure for the number of patients for whom it can provide a community diabetes service.  The service could be extended across the whole of the PCT through PBC, although their proximity to a number of major teaching hospitals is likely to preclude this in the early days.  The service provided is less expensive than hospital provision and provides continuity of care.  If negotiated and promoted well with local practices and their populations, the service would result in early efficiency gains across the health economy.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

Case Studies to Support Practice Based Commissioning

Eastern Birmingham Primary Care Trust Musculoskeletal Triage Scheme

Eastern Birmingham PCT was winner of the Improving Patient Access category last year’s HSJ awards. More than half of the 400 patient referred each month for orthopaedic assessment do not necessarily go to hospital.

Patients are seen by a community-based physiotherapy team and may be offered physiotherapy or given other forms of help outside hospital.  If they are sent to hospital it is with an exercise or pain management plan to help them until they get treatment.

GP referral letters are assessed within two days and around 70 per cent of patients are invited into physiotherapy centres.  The remainder may be passed straight to hospital, for example, where surgery is the only option.

Patients are seen by an extended scope physiotherapist within three weeks of their referral letter.  They may be advised to lose weight before a likely operation or asked to see their GP to address high blood pressure; many operations are cancelled at the last minute when patients are found to have untreated problems.

Other patients are suitable for treatment outside hospital, which could include physiotherapy exercises to aid mobility, occupational therapy and pain management.
 

Case Studies to Support Practice Based Commissioning

Referral Incentive Scheme

Practices in South Gloucestershire PCT are involved in a referral incentive scheme for which there are six domains.

Domain 1 - neither hospital spells (both elective and emergency) nor outpatient appointments exceed 2003/4 practice profile.

Domain 2 - Ten per cent of all adult dermatology patients in 2005/6 (including minor skin surgery) to be seen in primary care at South Gloucestershire GPSI dermatology service.

Domain 3 - Ninety per cent of all adult referrals in 2005/6, compared to 2003/4 profile to be sent to community heart failure service for triage.

Domain 4 - A&E attendances to be reduced by five per cent compared to 2003/4 profile.

Domain 5 - Eighty five per cent of all adult diabetic patients in 2005/6 to be managed in primary care.

Domain 6 - Eighty per cent of appointment to be mad using Choose and Book software from December 2005 onwards.

Practices receive £1.50 per patient if all six domains are met.  The payment structure is as follows:

Achievement of domains 1 and 2 – 50 pence per patient per practice.

Achievement of domains 3 and 4 – 50 pence per patient per practice.

Achievement of domains 5 and 6 – 50 pence per patient per practice.

Incentive payments to practices will be made in the early part of 2006/7 once the final activity position for 2005/6 is known, normally 4 – 6 weeks after year end.  However, the data the PCT provides practices is six months in arrears, which makes it very difficult for practices to know what to do to achieve the domain targets.

For further information contact Nicky Yates at Orchard Medical Centre, Bristol on 0117 9805114 or South Gloucestershire PCT.
 
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