Where we need to get to by 2011 Clare Smith Unit Operational Manager, Cardiac Aberdeen City...

Where we need to get to by 2011

Clare SmithUnit Operational Manager, Cardiac

Aberdeen City Community Cardiology Planning Day

• 18 Weeks RTT- Why?

• 18 weeks – what is counted and what isn’t?

• Where are we now?

• What do we need to do to move forward?


Waiting Times= Acute care• The Scottish Government has set out the vision for a stronger NHS

in Scotland that will make better use of NHS capacity to deliver a better deal for patients. A major element in achieving this vision will be a new national waiting time standard:

• From December 2011, 18 weeks will become the maximum wait for treatment following referral by a GP for non-urgent patients.

• “Better Health, Better Care” (Scottish Government, December 2007)

• The 18 weeks Referral to Treatment (RTT) Standard is an integral element of the strategic objectives set by the Scottish Government that will structure decision‑making and give clear focus to delivering better health services for the people of Scotland.


Why?• The end of queuing as a rationing

mechanism• The end of inequitable service• The end of an ever distancing tail• The end of the anxiety and worry

which goes with waiting• The end of stage of treatment

guarantees


What is Counted and What Isn’t?

The clock starts for a RTT period on the date of receipt

of referral to:

• a consultant-led service• a referral management centre


DefinitionsA Consultant Led Service is:• Where a Consultant retains overall clinical responsibility for the service, care,

professional team or treatment. This is applicable whether it be in the Acute or Primary Care setting

• The Consultant will not necessarily be physically present for each consultant led activity.

• Diagnostics are included within this provided the patient will be assessed and might, if appropriate, be treated by a medical or surgical consultant-led service before responsibility is transferred back to the referring health professional. This is also known as “straight-to-test”

• Direct access referrals to diagnostic services are excluded if the referral is not part of a straight-to-test referral pathway.

Referral Management Centre is:• A referral management centre is any service that incorporates any

intermediate levels of triage and assessment between traditional Primary Care and Secondary Care.


Case Study 1• Mrs. T was referred to the Dr Hannah’s consultant led CP clinic at her local hospital in

Peterhead. At the first outpatient appointment, Mrs. T was examined by the GPSI who diagnosed angina and commenced medical management.

• Although Mrs. T saw a GPSI rather than a Consultant, her 18 weeks RTT clock still started on the day that the hospital received the referral. This is because the clinic was running as an independent chest pain clinic as part of the Andrew’s team.

Case Study 2• Mrs V visited her GP complaining of breathlessness and palpitations. Her GP decided to

refer her for an echocardiogram at the local hospital cardiology department to help inform her of the best way to manage her condition.

• No 18 weeks RTT clock has started, as the GP has made a referral for diagnostic test with the intention that the responsibility for the patient remains with the GP: there is no immediate intention for the patient to go on to see a consultant-led service.

Case Study 3• Mr G attended his GP complaining of chest pains. His GP referred Mr G to his local hospital.

All referrals are triaged by clinical and administrative staff in the Referral Management Centre, who assessed the information contained in the referral document, and passed the referral (as per agreed protocols) to the chest pain clinic in the neighbouring hospital.

• Mr G’s RTT clock started when the referral was received by the Referral Management Centre, even though the hospital did not receive the letter until three days later.


What Does this Mean for Current Services in the Community?

What does this mean for current services in the Community?

• GPOA Echo = No waiting Times• GPOA ETT = No Waiting Times

• GPOA Holter = No Waiting Times• ARI and DAB GPSI CP Clinics = Waiting Times• Consultant Community Clinics = Waiting Times


Better Care Without Delay is about adding value to the patient

journey and ensuring patients access the appropriate Services

when they need to whether that be in the Acute or Primary Care

setting.


Where are we now?

Aberdeen City Cardiology Planning Day

12 Weeks Targets all DAB, ARI and Aberdeeshire met.


N.B. The RACPC Route is the same from AG onwards but has a 2 weeks appointment guarantee for the OPA.

Now12 wks

Cardiology OPA Revascularisation

16 wks

AG

26 wks


N.B. The RACPC Route is the same from AG onwards but has a 2 weeks appointment guarantee for the OPA.

2011

Cardiology OPA

<5 wks

AG

<9 wks

Revascularisation

<18 wks

RACPC Review

• Revision of RACPC and roll out across GP practices

• Clear referral routes• Timeous access to RACPC• Waiting Times


Number of Weeks Waiting Number of Patients on List

EchoGeneral

GPOA Echo

HoltersGeneral

GPOA Holter

GPOAETT

EchoGen

GPOAEcho

HoltersGen

GPOA Holter

GPOAETT

ARI 6-7mths28wks

2wks 8wks 15wks ________ 768 50 88 138 _________

DAB _______ _______ ________ _______ ________

______ ________

INV 16wks 2wks 9/10wks 53 0

KCH _______ 4wks _______ ________

_______ _______ 0 ________

________ ________

PHD 9wks _______ _______ _______ _______ 23 _______ ________ ________

TUR _______ 9wks _______ 19wks 1wk _______ 20 _______ 20 2


N.B No Waiting Times are applied to ‘General’ Diagnostics but they are being monitored by the Executive pending roll out.

• Better planning and scheduling of resources. (Readiness Assessment Tool)

• Planned alternative referral and treatment routes that speed up access and reduce waiting times allowing patients to be seen by the right person, in the right place, at the right time. (Readiness Assessment Tool)

• Centralised points of referral that minimise the number of queues and simplify communications for patients, healthcare professionals and the administrative and support teams. (Readiness Assessment Tool)

• Clear rapid signalling processes in the system that can alert all teams involved in a patient process about changes in service provision due to unforeseen circumstances such as absence/illness or interruptions to normal service. (Readiness Assessment Tool)

• Improvements in queue management through pooled lists and streamlined patient processes. (Readiness Assessment Tool)


What do we need?


Patient Centered Service Review

Developing a Plan for Aberdeen City •Community Cardiology i.e. shifting the balance of care out of the Acute

setting

•What does ‘Shifting the Balance of Care’ actually mean?

‘…improve the health of the people of Scotland by shifting the emphasis towards health improvement, preventative medicine and more continuous care in the community.

…We aim to improve access to care and treatment through a general shift in the location of services and care. For example, a wider range of diagnostic procedures and specialist services are being embedded into communities through Community Health Partnerships. We expect to see less acute hospital centred activity as we continue to develop our community infrastructure and community hospitals. This will enable us to get a better balance between planned and unscheduled care’ www.scotland.gov.uk

Model of Care One Size Does not Fit All


•Areas of commonality between Aberdeenshire and Aberdeen City i.e. need for GPOA Echo and Holters

For Discussion

•Is the GPsWI model correct for a City Solution?

•Should Community Cardiology be provided by Speciality Drs within the Community?

•How do the costs stand up?

Other Considerations for DiscussionPatient Considerations Resources

GPOA EchoGPOA HolterChest Pain NPOther Cardiology NPAll Re-referrals

CriteriaCompetenciesAccountabilityPatient Focused?AppropriatenessFrequencyWaiting TimesReferral Systems Training

PhysiologistsCardiologistsGPSWIRegistrarsSpecialist DrsCross CoverAdminITAccommodationCurrent Service levelsNurse-Led


Where we need to get to by 2011 Clare Smith Unit Operational Manager, Cardiac Aberdeen City...

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