David Colin-Thom é

PRIMIS Third National Conference Tuesday 1 April 2003

Birmingham

David Colin-Thomé

National Clinical Director for Primary Care

GP, Castlefields, RuncornVisiting Honorary Professor,

M.C.H.M, Manchester University


Birmingham

Primary Care

• GPs and their staff• Dentists• Pharmacists• Optometrists• Community Nurses


Birmingham

General Practice

Traditional• Personal Care• Co-ordination of Care• Continuity of Care• Longitudinal care• “Gate Keeper”


Birmingham

The P.M.’s Principlesfor the NHS

• National Framework of Standards and Accountability

• Devolution to the Local Level• Improved Rewards and Conditions of

Employment (Flexibility, Incentives, Rewarding Success, Shedding Bureaucracy)

• More Choice, More Contestability


Birmingham

NSFs

• Clinical Priorities for the NHS• Tackles areas of under performance• Evidence based clinical recommendations• Addresses all aspects of Anticipatory care• Quality framework for the whole care

system• All apply to Primary Care


Birmingham

PCT

Manager of the local NHS


Birmingham

FOR PATIENTS

• Choice

• Voice

• Control of their Care


Birmingham

“Diversity and Plurality are

Government Policy”

Secretary of State for Health


Birmingham

Primary Care Development

• PCTs supported by NatPaCT

• New GP Contract (GMS)

• PMS (PDS, LPS) • Other contracts • Appraisal• GPwSIs

• Medicines Management Collaborative

• Primary Care Collaborative

• N&AHPSI• OOH• R&R


Birmingham

A New Primary Care

• Access • Self Care• Modern Clinical Professionals• Modern General Practice• Integrated Care• Intermediate Care / Ambulatory Care• The Public’s Health• A New Public Management


Birmingham

Rapid Access

• NHS Direct

• Community Pharmacy

• GP Surgeries

• Community Premises

• Walk-in Centres

• Hospital

• Other Providers


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Self-Care – the informed patient

• NHS Direct Online

• Other Interactive software

• Digital TV

• The expert patient


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New GMS

• Practice based• Services – Essential, Additional and

Enhanced (National,Direct or Local)• 4 Domains of Quality (Clinical,

Organisational, Additional Services and Patient experience)

• Infrastructure, Aspiration and Rewards• Can opt out of OOH


Birmingham

Primary Care Nursing

• First Contact• Care of chronic conditions• Improving the health of the public• Prescribing• Referring• NwSI


Birmingham

Modern Pharmacy

• Information Resource• Walk in Services• Medicines Management• Anticipatory Care including CDM• New Primary Care Provision


Birmingham

What is “Intermediate Care”?

• Those services that do not require the resources of a general hospital, but are beyond the scope of the traditional primary care team. These services can include ‘substantial care’ for people with complex needs.

• This can also be described as Ambulatory Care


Birmingham

New PMS

• Where is PMS plus?• New Organisations (LPS, other PC

contractors)• Extended Contracts into the Hospital• The Broader Public Health• Local Accountability• Models for future iterations of GMS


Birmingham

What is “Integrated Care”?

• Integrated care and disease management are often used interchangeably, as the aim is to provide a systematic, multi-agency approach. IC applies to all health care interventions but DM principally applies to chronic illness.


Birmingham

Clinical Resource Management

• Case Management• Assertive outreach• Secondary to Ambulatory shift• Clinical Appropriateness• Expert Patient


Birmingham

“Medical costs rise to equal the sum of all private

insurance and Government subsidy”

Aaron Wildavsky’sLaw of Medical Money


Birmingham

Hospital Re-Design

• Out-Patients• Day Case Surgery• Orthopaedic scoping• DTCs• REC• Configuring Small Hospitals• Private Sector


Birmingham

Health Care in Context

• Social Gradient

• Stress

• Early Life

• Social Exclusion

• Work

• Unemployment

• Social Support

• Addiction

• Food

• Transport

David Colin-Thom é

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