Planned Care
What did we say in Healthy Ambitions?*
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The Planned Care pathway group identified ways in which planned care could be more efficient and effective, reducing variation and improving quality across the region.
They therefore recommended:
- A re-thinking about how general medical practice is supported to further develop clinical services and reduce the variation in outcome evidenced by Quality and Outcomes Framework indicators. This would entail developing strategies to deliver more specialised services for local populations that are covered by more than one practice; these would work more closely together in a federated way to improve local access.
- Further development of the GP with a special interest role by freeing up GP time through enhanced first contact capability by skill mixing. Much more could be done to broaden and enhance the services by dentists, community pharmacists, and optometrists with particular emphasis on health promotion and the management of long term conditions.
- Improved access to an increased range of local quality assured diagnostic/tests services for primary and community care clinicians by taking advantage of new technologies. This includes the use of approriate mobile services.
- Enabling much better integration between clinicians and diagnosticians through much fuller completion of test request forms to include symptoms and differential diagnoses. This will enable diagnosticians to advise on and undertake appropriate tests.
- Significant increase in self care, telecare and home monitoring by people with long term conditions.
- Over time there should be large reductions in the numbers of people seen in hospital based outpatient departments with 50% or more of new referrals being seen in local clinical settings. The numbers of follow up hospitals based outpatient appointments should also fall dramatically as more locally based clinics come on stream.
- The role of constant “point of contact” along the whole planned care pathway through professionals such as clinical nurse specialists should be developed and evaluated. *Full details can be found at: www.healthyambitions.co.uk/planned_care.html.
- Better communications between primary and community clinicians and hospital based clinicians with much better local access to a wide range of specialists in conditions such as diabetes and respiratory problems.
- The possibility of broadening the non acute services provided by ambulance services should be explored. This includes responsive patient transport services, transportation of notes, equipment and staff; examples of this are diagnostics and phlebotomy.
- The closer integration of primary and community clinicians with specialists should be supported by taking full advantage of capabilities of modern telecommunication and IT systems. This includes the ability to send standardised referrals to specialists. Such systems would contribute to mitigating at least in part the specialist opportunity costs incurred in community working.
- Fully integrated IT systems that link relevant clinicians caring for a patient are a fundamental to many of the Planned Care pathway recommendations.
- A wider range of and increased numbers of procedures will be done as day cases as locally as clinical facilities and safety will allow.
- There is no need to embark on a large building programme in advance of utilising current facilities to best effect. This includes extending weekday working beyond 9am-5pm as well as weekend working for planned care services.
- A regional review of the provision of intensive care with particular attention to Level 3 critical care provision; this includes Level 3 care proximity to and relationship with Level 2 care.
- A regional review of the provision of vascular services that covers the balance undertaken by vascular surgery and interventional radiology; this should take into account the latter speciality role in emergency medicine.
- As a result of the centralisations of upper gastro-intestinal (Upper GI) cancer surgery there should be a Regional review of the provision of non cancer Upper GI surgery.
Who is taking this work forward?
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PCTs across Y&H have worked with the SHA to agree which of the recommendations of the planned care pathway should be taken forward locally and which might need action at regional level. This is summarised in fig.2 on the next page.
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When is it happening?
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The actions to be taken forward in the first year of implementation for the Planned Care pathway are shown in fig.3.
Local delivery
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PCTs have prioritised the recommendations in Healthy Ambitions in light of the needs of their local community and the current position of their services.
Working with their local partners and providers they have all set out the action that they will take to start to turn the recommendations in Healthy Ambitions into reality in their five year strategic plans.
An example of the action being taken by Hull PCT is shown in fig.4.
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Who will make sure that this work happens?
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There are a number of key leadership roles in the delivery of this pathway:
Locally
Each PCT is responsible for working with local partners and providers to ensure the delivery of recommendations in line with their local priorities and their own strategic plans.
Collaboratively and Regionally
Delivery will be overseen by a Pathway Delivery Board – as described in the chapter on governance arrangements.
For Planned Care the chair will be Jan Sobieraj Chief Executive at NHS Sheffield, who will act as “the guardian” of the planned care recommendations in discussions amongst the CE community.
The clinical leads are Mark Baker, lead cancer clinician at Leeds Teaching Hospital Trust, and Ian Jackson, Consultant Anaesthetist at York Hospitals NHS Foundation Trust. They will oversee progress against the planned care pathway recommendations; act as champions for the recommendations; advise on delivery processes and encourage regional colleagues to continue to focus and give priority to the planned care recommendations.
The SHA’s Medical Director Chris Welsh will ensure that regional reviews of critical care, vascular sugery, urology, interventional radiology and upper GI take place with appropriate clinical involvement and governance arrangements – in discussions with the clinical networks and specialised commissioning group where appropriate.
How will we measure success?
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We have developed a 'Healthy Ambitions Dashboard' based on a small number of key indicators which taken together can be used to start to measure the success of Healthy Ambitions programme as a whole. This is underpinned by trajectories which each PCT will set to reflect their local priorities and circumstances. It will show the measurable improvements they are making in each pathway area. This will supplement the ‘vital signs’ indicators and trajectories which will support delivery of the targets set out in the NHS Operating Framework and the selection of outcome measures which PCTs have included in their strategic plans. In many cases these measures are one and the same. All of these measures will feature in PCTs annual operating plans to be agreed with the SHA and be the basis for the SHA’s performance management regime.
Recognising that the pathway recommendations are many and various, we intend to start by tracking progress against the key pathway pledge, which for the planned care pathway is to reduce the number of repeat journeys for patients and carers.
We know that this doesn’t tackle all the priorities in this chapter and that many other outcomes will be tracked through existing routes. GP practices offering extended hours, breast cancer screening rates and patient experience measures are all Vital Signs, whilst implementation of hip and knee best practice is a CQUIN measure.
The key indicators we will therefore track in the “Healthy Ambitions Dashboard” will be:
- Number of outpatient appointments per spell of treatment (hip and knee)
- Admission and re-admission rates (within 3 months) for hip and for knee
- Average length of stay (for hip and for knee)
- Day surgery rates for the basket of 25 procedures
Work has been undertaken to establish baselines for the pledge and by the end of March '09 trajectories for improvement will have been agreed between the SHA and PCTs and will be reflected in annual operational plans.* We intend to publish progress against individual trajectories.
*More details can be found in the performance metrics chapter.