GP+HFMA+presentation
- 1. ‘Medicine for Managers; General Practice’ Presented by Dr. Michael Gregory, Clinical Director for Strategy and Policy for Trafford CCG Chaired by Andrew Wood Chief Finance Officer at Fareham & Gosport and South Eastern Hampshire Clinical Commissioning Groups 23rd January 2014 - 11.00am-12.00pm
- 2. Housekeeping Guy Mitson, e-learning manager, hfma • Do put your questions to our speakers! • Type your questions in as you think of them, rather than waiting until then end. • Try refreshing your browser if you have any audio problems and check your internet connection. -For more technical help, click on the ‘Test your System’ at the bottom of the screen. • Please leave a rating so that we can maintain and improve your webinar experience. • Webinar and presentation will be available on the HFMA site straight after this webinar finishes .
- 3. Primary Care Dr Michael Gregory General Practitioner West Timperley Medical Centre Altrincham, Cheshire. Clinical Director Trafford CCG.
- 4. • An introduction to general practice. • The role of GPs in healthcare and the services provided • How general practice is financed • Current challenges for general practice • Future developments that will impact on general practice.
- 5. A bit of history….. National Insurance Act 1911
- 6. 1946 - Creation of NHS
- 7. 1950 -Collings Report 1952 - Danckwerts Award 1966 - General Medical Services Contract
- 8. 1952 – Creation of RCGP
- 9. 1980s - increased scrutiny 1990s - evolving roles 2004 - GP contract 2013 - Health and Social Care Act
- 10. The Importance of Primary Care
- 11. Questions
- 12. Role of GPs ‘personal doctors, primarily responsible for the provision of comprehensive and continuing generalist care to every individual seeking medical care irrespective of age, sex and state of health’.
- 13. GP Training Primary Care Management Person centred care Specific problem solving skills Comprehensive approach Community orientation Holistic approach
- 14. GP Training Medical Degree 5 years Foundation training (usually in medicine and surgery) 2 years Speciality Registrar Specialities 18 months Practice 18 months
- 17. HSCIC 2009
- 18. HSCIC 2009
- 19. HSCIC 2009
- 20. HSCIC 2009
- 21. Question
- 22. 2004 Contract General Medical Services Personal Medical Services Alternative Personal Medical Services
- 23. Global Sum • MPIG • Correction Factor
- 24. Quality and Outcomes Framework • Clinical Domain • Public Health Domain • Quality and Productivity Domain • Patient Experience
- 25. Question
- 26. Clinical Domain • Atrial fibrillation (AF) • Coronary heart disease (CHD) • Heart failure (HF) • Hypertension (HYP) • Peripheral arterial disease (PAD) • Stroke and transient ischaemic attack (STIA) • Diabetes mellitus (DM) • Hypothyroidism (THY) • Asthma (AST) • Chronic obstructive pulmonary disease (COPD) • Dementia (DEM) • Depression (DEP) • Mental health (MH) • Cancer (CAN) • Chronic kidney disease (CKD) • Epilepsy (EP) • Learning disabilities (LD) • Osteoporosis: secondary prevention of fragility fracture (OST) • Rheumatoid arthritis (RA) • Palliative care (PC)
- 27. Public Health Domain • Cardiovascular disease – primary prevention (CVD- PP) • Blood pressure (BP) • Obesity (OB) • Smoking (SMOK) • Cervical screening (CS) • Child health surveillance (CHS) • Maternity (MAT) • Sexual health (CON)
- 28. Other Domains • Quality and Productivity Domain • Patient Experience
- 29. Quality and Outcomes Framework
- 30. The physical activity index categorises patients’ level of activity, which is correlated to CVD risk. Patients are categorised as: 1. Inactive – sedentary job and no physical exercise or cycling 2. Moderately inactive – sedentary job and some but less than one hour of physical exercise and/or cycling per week or standing job and no physical exercise or cycling 3. Moderately active – sedentary job and one to 2.9 hours of physical exercise and/or cycling per week or standing job and some but less than one hour of physical exercise and/or cycling per week or physical job and no physical exercise or cycling 4. Active – sedentary job and three hours or more of physical exercise and/or cycling per week or standing job and one to 2.9 hours of physical exercise and/or cycling per week or physical job and some but less than one hour of physical exercise and/or cycling per week or heavy manual job. It is advised that all patients who receive a score of 'less than active' are offered a brief intervention supporting behaviour change to increase physical activity.
- 31. Exception Reporting • Explicit rejection • No response to invitations • Patient unsuitable • On maximum tolerated therapy
- 32. Enhanced Services • Direct Enhanced Services • National Enhanced Services • Local Enhanced Services
- 33. Contract Changes 2013/14 • New vaccination programmes • Enhanced Services (NHS England): • High risk of admission patients • Dementia • Remote care monitoring preparation • Electronic booking
- 34. Contract Changes 2014/15 • Enhanced services: • People at risk of admission • Abolition of risk profiling DES, patient online booking DES and Remote care monitoring DES. • 341 QoF points retired • 238 points into core funding and remaining to fund enhanced services • MPIG phase out • Seniority phased out
- 35. GP Income • 20% decline since 2005/6 • Expense rise of 56.5% of earnings in 2004/5 to 61.6% in 2011/12.
- 38. Barriers • Prescribing • Secondary care activity • Choice agenda • Competition and collaboration • IT
- 40. Nuffield – Securing the Future of General Practice 2013. • improving population health, particularly among those at greatest risk of illness or injury • managing short-term, non- urgent episodes of minor illness or injury • managing and coordinating the health and care of those with long-term conditions • managing urgent episodes of illness or injury • managing and coordinating care for those who are nearing the end of their lives.
- 42. Future of General Practice • From solo practitioner to multi professional team • Value generalism whilst embracing specialist knowledge • Developing shared care • Wider range of integration • From gatekeeper to navigator • Support SDM and self care