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