the life of a general practitioner in the national health service (nhs) dr amir hannan full-time...

The Life of a General Practitioner

in the National Health Service (NHS)

Dr Amir HannanFull-time General Practitioner

Information Management & Technology leadTameside & Glossop PCT

Member of the Records Access CollaborativeMember of the HealthSpace Reference Panel

Member of the Clinical Leaders NetworkMember of the Primary Healthcare Specialist Group (branch of the British Computer Society)

amir.hannan@nhs.net

City UniversityLondon

10th October 2007

See notes below each slide to see what I said

Setting the scene

• 12,000 patients on 2 sites, 6000 each• 7 GPs (6 whole time equivalent)• 4 nurses and 2 health care assistants• Practice Manager and Assistant Practice Manager• 39 members of staff (mainly part-time)

(But thankfully we switched over to exclusive use of the computer about 2 years ago)

What do we do?

www.haughtonthornleymedicalcentre.co.uk

• Routine surgeries with Advanced Access (to schedule appointments up to 6 weeks in advance) with doctor or nurse

• Visit patients in their own home• Baby clinic• Nurse-led chronic disease clinics• Phlebotomy clinic• Warfarin / INR clinic• Minor surgery clinic• Midwife clinic• Counselling clinic• Primary care mental health clinic• Drug misuse clinic• Alcohol misuse clinic• Teaching medical students • (Hoping to become a Training Practice soon)

Self-care Primary Care1o

Secondary Care2o

Tertiary Care3o

Personal health beliefsFriends and family

PharmacyHealth shops

TV, radio, magazines,

Internet

General PracticePharmacy

OptometristsPodiatrists

Community nursing clinics

Local district General hospital

Specialist hospital

Increasing complexityGreater cost

Smaller number of people1o

2o

3o

Self care

ICATS

Health Authority

GP practices

CommunityHealth VisitorsDistrict Nurses

Community Mental Health Team

Acute Trust

ManagementClinicians

“Old” organisations working within Tameside & Glossop

Practice ManagersReceptionistsSecretaries Counsellors

Nurses

Local Medical Council

GPs

PCTChief Executive

PCT BoardPEC

Directors eg FinanceClinical LeadsRBMS / Tier 2

Communications Manageretc

GP practices

CommunityHealth VisitorsDistrict Nurses

Community Mental Health Team

Specialist nurses eg dermatology

GPSIsSalaried GPs

Out of Hours service

Strategic Health Authority

Acute Trust

ManagementClinicians

Social Services

Patient Participation GroupsPatients

Voluntary Sector

MINDVictim SupportAge Concern

Local Government

OthersHealth Protection Unit

Immunisation Co-ordinatorOldham PCT

Different organisations working within Tameside & Glossop PCT

Practice ManagersReceptionistsSecretaries Counsellors

Nurses

Local Medical Council

GPs

Pharmacists

Co-opIndependents

SHA Community

Acute Trust

Others

General Practice

Patient

PCTSocial services

Pharmacists

Voluntary sector

Local government

3-D View of Reality Today showing Complexity of Communication

Acute Trust

Acute Trust

Acute trust

PCT

PCT

PCT

Life expectancy

Life expectancy UK average 78.8

• Population 245,000• The PCT provides services out of 14 clinics• Net Operating Costs for 2006/07 £311,000,000Total PCT employed staff• 1030 (including podiatrists, physiotherapists, health visitors, community

nurses, dieticians, orthoptists, community dentists, occupational therapists, school nurses, speech and language therapists, specialist nurses and nursery nurses).

Staff contracted to the PCT:• General Practitioners 125 working from 39 practices• Dentists 89 • Opticians (premises) 35• Pharmacies 51Key Partners• Tameside and Glossop Acute Services NHS Trust, Pennine Care NHS

Trust, North West Ambulance Service, Tameside Metropolitan Borough Council, High Peak Council, Derbyshire County Council, Third Sector Coalition (representing voluntary services in Tameside), Glossop Voluntary Services Bureau.

Tameside & Glossop Primary Care Trust

The Challenges for the PCT

• Diabetes• Obesity• Adult mental health• Dental health• Sexual health and teenage conceptions• Children’s health

Tameside & Glossop PCT annual report 2006-07

What do I do?

• What the patient wants?• Or needs?• Do my surgery in the allocated time?• Maximise assessment and treatment of everything!• Maximise practice profits• Provide better / greater access• Provide HIGH QUALITY CARE…• … but is that a holy grail?

What help is available

• IT systems in general practice• Quality and Outcomes framework• QMAS• Dr Fosters• Chart

The Quality and Outcomes Framework (QOF)

4 domains – each domain consists of a set of measures of achievement known as indicators against which practices score points according to their level of achievement

Clinical domains (655 points)Coronary heart disease (10 indicators)Heart failure (3)Stroke & TIA (8)Hypertension (3)Diabetes (16)COPD (5)Epilepsy (4)Hypothyroidism (2)Cancer (2)Palliative care (6)Mental health (4)Asthma (2)Dementia (2)Depression (2)Chronic Kidney Disease (4)Atrial fibrillation (3)Obesity (1)Learning disabilities(1)Smoking (2)

Organisational Domain (181 points)Records and Information (12)Information for patients (4)Education and training (8)Practice Management (10)Medicines management (9)

Patient Experience Domain (108 points)

Additional Services Domain (36 points)Cervical screening (4)Child health surveillance (1)Maternity services (1)Contraceptive services (2)

Holistic Care payment (20 points)

www.primis.nhs.uk

Chart data down to individual patient (only viewable by the practice)

Once data from a practices is uploaded, it can be compared with others via Chart Online

Family of classifications

Sharing the records

Immediate Care

Continuing Care

Preventative

Health Promotion

Patients Public

Admin Government Standards

Science & Research

Clinicians

A typical day for a GP

A typical day for the GP• Start at 8:00am• Surgery starts at 8:40am• Typically ends around 12:30pm• 2-3 visits taking about 1-2 hrs• “Paperwork”, review test results and scans, sign prescriptions (1-2

hrs)• Contact other patients / clinicians• (Meet with staff)• Afternoon surgery starts at 3pm • Ends around 5:30pm• More paperwork, scripts and other queries• (Management meetings)• Work at Out of Hours service

Using the Clinical System

EMIS clinical system

Choose and Book

www.chooseandbook.nhs.uk

Visits and IT systems• Paper summary of record

Includes Demographic details of patientSignificant active / past problemsCurrent medication and allergiesUp to the last 7 consultations (in surgery, telephone,

visits)Excludes Letters, recent test results, previous consultations

• Personal Digital Assistant (PDA)Includes All consultations

All test resultsScanned letters are difficult to readDifficult to enter information in reasonable time

• EMIS MobileIncludes Full EMIS system on laptop

All three systems require “synchronisation” after returning to the surgery

IT in the consultation

My consulting room

Depression…

• Is an illness just like breaking a leg

• Sometimes you can find a cause for it…

• Sometimes you just can’t

Symptoms

Anxiety

Excessive worry

Muscle tension

Sleep disturbance

Restlessness

Agitation

Fatigue

Poor concentration

Irritability

Depressed mood

Loss of interest

Weight Loss / Gain

Guilt

Suicidal ideation

Treatment options

• Anti-depressant tablets

• Seeing a CPN (Community Psychiatric Nurse) to talk through unresolved issues

• Time off work

Anti-depressants

• Anti-depressants are NOT addictive

• Like painkillers, they help to soothe the pain and suffering

• They do NOT work immediately

• Like antibiotics, you have to complete a course…

Low

Depression and Anti-depressants

Normal

2-3 months 6 months

MOOD

www.mom-e.com

Any Questions?

Real-Time Digital Medicine

What if patients could access the same

electronic health records as we can

from anywhere and at any time?

Imagine a world where…

• YOU are in charge of YOUR health• YOU can see YOUR own record• YOU can see what YOUR doctor / nurse / other health

professional has discussed with YOU• YOU can see results as soon as they arrive in the practice• YOU can see any letters that come into the practice about you• YOU can show the clinician the relevant parts of YOUR record• YOU can understand YOUR record better than anyone else• YOU can let someone see what is happening even if YOU do

not speak a word of English• YOU can access your record from anywhere in the world

Imagine a world where…• YOU can check YOUR medical record is correct, free of any

mistakes• YOU can see the SAME information as the clinician in front of

you• NO DOCTOR CAN EVER HIDE ANYTHING IN YOUR

RECORD LIKE SHIPMAN DID AND GET AWAY WITH IT• Patients in Hyde can stand up PROUDLY and show the

WORLD how THEY helped to put the medical profession back in its rightful place

• Patients can TRUST doctors and the rest of the medical profession and we EARN their RESPECT again.

• We can JUST BE!

• A collaboration between EMIS , PAERS, GPs and Patients

• A generic solution that is not clinical system-specific• As secure as the banking world with plans for 2 factor

authentication

www.patient.co.uk/surgery.asp

7399 2558 HAUGHTON1

www.healthspace.nhs.uk

Real-Time Digital Medicine

Benefits of patients accessing

electronic health records

• Efficiency• Clarity• Safety• Process is time neutral• Effectiveness

Real-Time Digital Medicine

The Paradigm Shift in Healthcare

For ALL, not just the precious FEW

Structures

Processes

Outcomes

Towards a Partnership of Trust

Challenges for US to consider• Implied consent AND explicit consent• Summary Care Record AND Detailed Care Record• Standards for disclosing, and recording information• Ignorance on Records Access• Cost of Records Access• Tools for patients to use Records Access• Local Care Record Development Board• “Market forces”, legislation and professional bodies• Managing change in a Paradigm Shift• Privacy, Security & Confidentiality vs Access to Information• Decision Aids and Information Prescriptions• Digital Divide & health inequalities• Trustworthy information portals• Semantic Interoperability in a global market• What will success look like?

By next year, at least half of these should be resolved: HOW CAN YOU HELP ?

www.icmcc.org

www.patientra.co.uk

World Health Organisation submission