8th collaborative digp/ucc/hse/ipna diabetes in primary care conference the challenges of delivering...
TRANSCRIPT
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8th Collaborative DiGP/UCC/HSE/IPNA Diabetes in Primary Care Conference
The Challenges of Delivering Diabetes Care in General Practice
Professor Mike Pringle
President, RCGP
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First, an apology
I am a GP
I retired from clinical practice 4 years ago
I am English…
But we share similar underlying challenges and are searching for similar solutions
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How did we get here?
The essential value of Generalism
The clear benefits of teamworking, integration and collaboration
Personalisation against standardisation of care
Autonomy versus regulation
What does ‘success’ or ‘best care’ look like?
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The Context
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The rise in numbers and complexity
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Single Disease specific solutions will not work
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The Impact
3 59 14 21
3447
6485
100
151
20
3151
74
115
151
200
242
318
342
479
0
100
200
300
400
500
600
0 1 2 3 4 5 6 7 8 9 10+
Ann
ual a
dmis
sion
rate
per
100
0 pa
tien
ts
No of conditions
Potentially preventable admission
Other emergency admissions
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Ageing and multiple morbidity
• People with LTCs:29% of the population
50% of all GP appointments
64% of all OPD appointments
70% of in-patient bed days
70% of total health and social care spend
• The Number of people aged over 80 will double between 2010 and 2030
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The capacity of UK general practice
In the 20 years to 2008, the primary care consultation rate increased by 75%
Over that period, consultations/pat/year rose from 3.9 to 5.5
The average GP consultation lasts 11.7 minutes
96% of patients say they want longer appointments
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The capacity of UK general practice
2001-2011 the FTE number of GPs increased by 2% per year
Between 2001 and 2011 District Nurses numbers fell 34%
FTE numbers of practice Nurses peaked in 2006 since when we have lost 7%
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Effect of deprivation in the UK
Health inequalities are widening
The Inverse Care Law is alive and well
• In Scotland 11% more GPs in the most affluent half of population than in the other half
• In England CCGs with highest provision had twice the numbers of GPs per capita that those CCGs with fewest GPs
• Consider English male life expectancy and GP distribution
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Effect of deprivation
Multi-morbidity (esp mix of physical and mental) occurs on average 12 years earlier in most deprived vs most affluent quintiles
“More multiple morbidity in deprived areas means that the population die younger, are sicker for longer before they die and they present more complex problems to their GP”
RCGP, 2022 vision, 2013
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Continuity of care
Continuity of care, a key attribute of generalism, gives:
• Earlier diagnosis
• Better health outcomes
• Patient centred care and higher satisfaction
• Cost control: less duplication, expensive interventions better targeted, better prescribing
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Fragmentation of care
Multiple contacts with different parts of the health service = lack of coordination, duplication of services, increased costs
In general practice, fragmentation = loss of continuity of care
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Shared decision making
This is not abdication but responsible sharing
At the centre is ‘care planning’, education and support
Average person with diabetes spends 3 hours a year face to face with a health professional; its the choices in the other 8,757 hours that really determines their outcome.
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SOME SOLUTIONS
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The RCGP Vision
“More GPs, with longer training, spending more time with their patients – A world where excellent patient-centred care in general practice is at the heart of health care”RCGP, 2022 vision, 2013
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The RCGP’s actions
• Campaign: Putting Patients First, Back General Practice
• Simon Stevens’ Five Year Forward View
• The Political rhetoric
• Recruitment, retention, returners
• Investment?
• Building teams
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Ways Forward
Promote ‘Federations’ or similar structures
Use Commissioning in England to recognise and fund primary care provision
Move care and services, and the funds, back to general practice
Recruit more of the emerging doctors into general practice
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Ways forward
Improve our skill mix, especially reverse decline in practice nurses
Telephone triage and telephone/email consulting
GPs and nurses with special clinical interests
Use pharmacists better
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Ways Forward
Care planning for people with multi-morbidity, with Primary Care retaining/regaining central role
Better IT and information sharing
Redesign pathways around the patient not the staff
Invest in primary care rather than secondary care
Encourage a “named doctor” and doctor-doctor-nurse-nurse pairing in big practices
Promote self care and shared decision making
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8th Collaborative DiGP/UCC/HSE/IPNA Diabetes in Primary Care Conference
Update on Diabetes – delivering care
Professor Mike Pringle
President, RCGP