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
The National Primary Care Research and Development Centre
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
The National Primary Care Research and Development Centre
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
The National Primary Care Research and Development Centre
Primary Care Trustsapprox. 200,000 population
Primary Care Community Services Health
Services
Strategic Health Authoritiesapprox. 1.5 million population
Hospitals
Funding
The National Primary Care Research and Development Centre
Primary Care Trustsapprox. 200,000 population
Primary Care Community Services Health
Services
Strategic Health Authoritiesapprox. 1.5 million population
Hospitals
Information Flows
The National Primary Care Research and Development Centre
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
The National Primary Care Research and Development Centre
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
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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
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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
% of PCG/TsCurrent Planned
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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
% of PCG/TsCurrent Planned
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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
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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
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GP systems - current position
High level of computerisation Accredited GP systems Erratic development Data quality questionable
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Research Questions
What are the information needs of PCGs and PCTs?
Do current information systems meet needs?
How can information systems be improved?
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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
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% 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
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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
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% of PCG/Ts reporting more than half of practices using selected links
0 20 40 60 80 100
Telemedicine
PCG/T
Pathology
NHS Net
Internet
Items of Service
Registration
% of PCG/Ts
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% 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
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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
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% 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)
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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
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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
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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
The National Primary Care Research and Development Centre
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
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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
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