The National Primary Care Research and Development Centre Primary Care Trusts: modernising the NHS?...

The National Primary CareResearch and Development Centre

Primary Care Trusts:modernising the NHS?

Diane Jones

Research Fellow

The National Primary Care Research and Development Centre

Overview

PCGs and PCTs in the new NHS National Tracker Survey of PCGs & PCTs Research findings Conclusions


Primary Care Groups and Trusts in the New NHS

One of the most radical reforms since 1948

Modernisation agenda reliant on PCTs

IfH reliant on PCTs


Health Service Reforms

Core Functions of PCG/Ts: Improve health of the local population Commission hospital & community

based health services Develop primary & community health

services


Primary Care Trustsapprox. 200,000 population

Primary Care Community Services Health

Services

Strategic Health Authoritiesapprox. 1.5 million population

Hospitals

Funding


Primary Care Trustsapprox. 200,000 population

Primary Care Community Services Health

Services

Strategic Health Authoritiesapprox. 1.5 million population

Hospitals

Information Flows


The National Tracker Survey of PCGs and PCTs in England

Longitudinal survey - 72 PCGs Oct-Dec 1999, Oct-Dec 2000 Jan-Mar 2002 Describe/evaluate achievements and

obstacles Interviews - CEO, Chair, HA Lead Postal questionnaires


Modernising Primary Care

Improving access Extending the range of services Increasing the workforce capacity Integrating primary and community services Improving quality Information and IT systems


Initiatives to improve access

0 20 40 60 80 100

Walk-in centres

Reduced list sizes

Pharmacist led services

Extended opening

Appointment systems

Healthy living centres

Nurse-led services

Target poorly served areas

% of PCG/TsCurrent Planned


Extending the range of services through sharing

0 20 40 60 80 100

Complementary therapists

Minor surgery

Outreach clinics

Specialist GPs

Community psychiatric nurses

Specialist nurses

Physiotherapists

Counsellors



Enhancing workforce capacity

0 20 40 60 80 100

Promote recruitment of GPs

Redistribute workforce

Extend role of pharmacists

Salaried GP schemes

Develop nurse specialists

Employ nurse practitioners

GP clinical specialists



Primary CareElectronic Patient

Record

Mental Health Services Electronic Patient Record

Hospital based Electronic Patient Record

Community Services Electronic Patient Record

Social Care Records

The Vision


Modernising Information Systems

Are information systems meeting the needs of PCG/Ts?

Will the targets set out in Information for Health and NHS Plan be met?

Development of IM&T in general practice


GP systems - current position

High level of computerisation Accredited GP systems Erratic development Data quality questionable


Research Questions

What are the information needs of PCGs and PCTs?

Do current information systems meet needs?

How can information systems be improved?


IM&T in PCGs and PCTs

Postal questionnaire - IM&T Lead Response rates

• Year 1 53 % (n=38)• Year 2 72% (n=51)

Case Studies Selected Findings


% of PCG/Ts where information systems meet needs well or very well

0 10 20 30 40 50

Health needs assessment

Workforce planning

Monitoring service provision

Commissioning

Clinical governance

Budget monitoring

Prescribing

% of PCG/Ts


PCG/T Information Systems

Poor/ very poor data from:• Community Health systems (84%)• GP systems (63%)• Hospital based systems(63%)

Most had e-links to NHS Net & Internet Few with e-links to practices & hospitals


% of PCG/Ts reporting more than half of practices using selected links

0 20 40 60 80 100

Telemedicine

PCG/T

Pathology

Email

NHS Net

Internet

Items of Service

Registration

% of PCG/Ts


% of PCG/Ts reporting more than half of practices using information management tools

0 20 40 60 80 100

MIQUEST

PRODIGY

Disease Management Guidelines

Data entry/extraction protocols

Computerised prescribing protocols

Read Codes

% of PCG/Ts


Education and Training

24% had an E & T policy for IM&T 46% aimed to by April 01

23% of PCG/Ts signed up to PRIMIS 26% had plans to sign up to PRIMIS


% of PCG/Ts confident of meeting national targets

0 20 40 60 80 100

24 hr emergency access torecords (2005)

Electronic patient records inuse (2004)

Use NHS Net for bookedappointments (2002)

Use NHS Net for lab. results(2002)

Access to NELH (2002)

All practices connected toNHS Net (2002)

Monitor GP referral rates(2001)


Obstacles to progress on IM&T targets

Inadequate levels of IM&T staff (71%) Poor budget information LIS does not reflect PCG/T needs Funding diverted


Obstacles to Progress - general (PCG/T Chief Officers)

0 20 40 60 80

Board working

Time/pace of change

GP attitudes

HA support

Resource constraints

Inadequate infrastructure

1999 2000

1


Conclusions

PCG/Ts are: taking action to improve access to primary care extending the range of services by sharing

resources between practices working to increase capacity through extended

professional roles


Conclusions

Development of primary and community services - high priority for PCG/Ts

PCG/Ts are making an important contribution to NHS modernisation

Inadequate management capacity and resources are seen as major obstacles to further progress

Continuing tension between central control and local autonomy


Conclusions

Information to support core functions is inadequate Ability to meet national targets is doubtful Practice systems - key source of data GP systems advanced but data quality inadequate Use of information tools in general practice very low Essential to improve data quality Substantial investment required


The Third Tracker Survey

Third survey underway

Findings published in Autumn 2002

www.npcrdc.man.ac.uk

The National Primary Care Research and Development Centre Primary Care Trusts: modernising the NHS?...

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