tag:blogger.com,1999:blog-49955952335794901412024-03-13T05:21:09.487+00:00A stone in the shoeA stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.comBlogger46125tag:blogger.com,1999:blog-4995595233579490141.post-53823870902281985882020-02-25T09:28:00.000+00:002020-02-26T08:52:35.017+00:00I have a rare disease - Angiosarcoma<br />
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<span style="font-family: "arial" , sans-serif; font-size: 14.0pt; line-height: 107%;">I have
a rare disease<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;">That should be I ‘had’ a rare disease as I finished my
treatment three years ago and I am still clear of the rare cancer called Angiosarcoma
that was found on my back.<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;">I am lucky in that my wife, family and friends were here to
support me. But I was also used to life in a hospital as I had worked as a
biomedical scientist in a London teaching hospital and as part of my job I used
to go to the wards and operating theatres.<span style="mso-spacerun: yes;">
</span>I was used to the language & terminology of medicine. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;">This background of working in healthcare meant that I was
not really anxious about the new situation I found myself in in autumn 2016
when I found out that I had cancer.<span style="mso-spacerun: yes;"> </span>Yes,
I was a bit worried but I was positive that I would be back to doing the things
I did before cancer as soon as I could.<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;">I can understand how people get very emotional about getting
a diagnosis of cancer and going into this rather alien environment that is a
hospital. I spent about ten days on the ward and I used to chat to my fellow
patients and some of them were very anxious.<span style="mso-spacerun: yes;">
</span>It is scary being on your own, away from family & friends, especially
if you were in a specialist centre a long way from your own home as we were. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;">This sense of isolation that someone with a rare disease
feels is one of the important lessons I learnt from my experience. Even on the
ward of this specialist hospital we were all in different situations and
different stages of our life with disease. Some had been in and out of hospital
over several years with complications. All of us had had life changing experiences.
<i>(I almost forgot that I was in the same situation as them and typed ‘them’ instead
of ‘us’!)</i>.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;"><span style="mso-spacerun: yes;"><br /></span></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;">I found myself observing the activity within the ward, watching
the interaction of staff & patients.<span style="mso-spacerun: yes;">
</span>I had spent some time working in change management in the NHS & in
quality improvement. Here was my opportunity to experience it first-hand. It was
an interesting experience being a patient and then as I recovered, an observer.<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;">The thing that made the biggest impression on me was the
need for good communications about what was going to happen to us and also the
need for emotional & psychological support for both patients & relatives’/carers
while we are in hospital & on our return to our home.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;">It is a shock being told you have cancer. It is a shock
going into hospital. It is a shock going home.<span style="mso-spacerun: yes;">
</span>When you have a rare disease, it is an even bigger shock as there isn’t
any local knowledge about your condition. Clinicians may only see one example
in their working lives and that is you!<span style="mso-spacerun: yes;">
</span>You probably know more about it than they do. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;"><br /></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;">By the way I discovered that a friend of 45 years also had
the same cancer as I did so perhaps my statement is a bit of a generalisation.<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;">So, these are my thoughts on Rare Disease Day Feb 29<sup>th</sup>
2020.<o:p></o:p></span></div>
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<b><span style="font-family: "arial" , sans-serif; font-size: 16.0pt; line-height: 107%;">Please
provide more emotional & psychological support for rare diseases.</span></b><span style="font-family: "arial" , sans-serif; font-size: 12.0pt; line-height: 107%;"><o:p></o:p></span></div>
<br />A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-66988382154660458462018-03-21T11:49:00.001+00:002018-03-21T11:50:21.053+00:00What is the Buckinghamshire Integrated Care System?<br />
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I attended the Buckinghamshire Health and Social
Care Integration Summit in November 2017 when the new Integrated Care System was discussed by representatives from the local authorities, health care system, local charities & the voluntary sector and some members of the public (me included). </div>
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Sadly the presentations went over time so there was no time for questions (not good!) but I did send my questions into the organisers. I have now received the response to those questions.</div>
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Of course the name of the new system has been changed in the meantime. However the purpose of the new system remains the same. So for Accountable Care System (ACS) please read Integrated Care System (ICS).</div>
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<b style="mso-bidi-font-weight: normal;"><u><br /></u></b></div>
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<b style="mso-bidi-font-weight: normal;">Q1. Is there any extra
funding for Buckinghamshire ACS to invest in Public Health & community services?<o:p></o:p></b></div>
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<b style="mso-bidi-font-weight: normal;"><br /></b></div>
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Answer: NHS England is offering Accountable Care System (ACS) transformation
money to support us to meet our priorities and go further, faster.
Opportunities to bid for further funds do often arise.<o:p></o:p></div>
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<span style="font-size: 12.0pt; line-height: 115%;">In addition
to monies that may be made available through the ACS, we are investing £1
million in community services, bringing together nurses, therapists, social
workers, GPs and other relevant organisations to provide 24/7 cover for people
who need the greatest health and care support and give them better, more
coordinated care in their homes.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-size: 12.0pt; line-height: 115%;"><span style="mso-spacerun: yes;"><br /></span></span></div>
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<b style="mso-bidi-font-weight: normal;">Q2. ‘Accountable’ to whom?
How can the public hold this new organisation, which most know nothing &
were not consulted on, to account?<o:p></o:p></b></div>
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<b style="mso-bidi-font-weight: normal;"><br /></b></div>
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Answer: The ACS is not a new organisation, it’s about further
developing our system way of working, which supports:<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b>Joined
up working</b><span style="mso-bidi-font-weight: bold;"> between<b> </b></span>health
and social care services to provide better care and help people to stay healthier<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Staff
to <b>work together </b><span style="mso-bidi-font-weight: bold;">easier across
our provider and commissioner organisations</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->More
<b>local control </b>and <b>freedom</b> to make decisions<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Extra
support to go further and faster in <b>improving services</b><o:p></o:p></div>
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It will allow us to have stronger local relationships and
partnership work based on <span style="mso-bidi-font-weight: bold;">common
understanding of local priorities, challenges and next steps.</span><o:p></o:p></div>
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<span style="mso-bidi-font-weight: bold;"><br /></span></div>
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<b style="mso-bidi-font-weight: normal;">Q3. How will the public
know that the ACS has achieved its purpose, indeed what is its purpose?<span style="mso-spacerun: yes;"> </span>What baseline measures do you have for
outcomes, organisational, financial and patient outcomes, so we can compare the
improved public health & other outcomes in the future?<o:p></o:p></b></div>
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<b style="mso-bidi-font-weight: normal;"><br /></b></div>
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Answer: The purpose of our system working is to achieve our vision
for “One Buckinghamshire, one integrated health and care system”, by further
developing our community-focused approach to integrating services and
collaborative working across the county.<span style="mso-spacerun: yes;">
</span><o:p></o:p></div>
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We have a track record of success on working collaboratively
to improve quality, transform service models and build financial
sustainability. Some of our successful working to date includes: <o:p></o:p></div>
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A system wide Primary Care Strategy,<span style="mso-spacerun: yes;"> </span>agreed in 2015 and with strong clinical
leadership across primary care that has seen the development of a nationally
recognised innovative alternative, the Quality and Outcomes Framework, with
outcomes that build a ‘fit for purpose’ future primary care service. This has
established a care and support planning approach in primary care resulting in
Buckinghamshire being the best for diabetic glucose control in the country. <o:p></o:p></div>
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A Buckinghamshire Provider Alliance agreed between FedBucks,
Oxford Health NHS Foundation Trust and Buckinghamshire Healthcare NHS Trust,
with a commitment to integrate seamless services for patients;<o:p></o:p></div>
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Care Closer to Home – Integrated Adult Community Healthcare
teams have provided 24/7 services since 2012. Locality led initiatives include
the introduction of the Airedale model remotely supporting care homes and
enhanced primary care teams supporting frail elderly people developed from our system
work on Multi Agency Groups;<o:p></o:p></div>
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We are piloting the development of Community Hubs including
increased community based services, short term packages and a new frailty
assessment service, reducing the use of overnight community beds;<o:p></o:p></div>
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A collective approach to engagement – with a single
communications and engagement team across Buckinghamshire County Council and
the Clinical Commissioning Groups working closely with colleagues in provider
trusts.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Q4. One example of an ACS
in Canterbury in New Zealand. This has taken ten years to achieve its aims and required
extra funding for public health, community services & social care.<span style="mso-spacerun: yes;"> </span>We do not have the luxury of time not it
seems any investment.<span style="mso-spacerun: yes;"> </span>We need
improvements now to maintain the quality of care services & to improve outcomes.
Can this ACS do in a short time what took Canterbury 10 years to achieve &
without extra funding?<o:p></o:p></b></div>
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<b style="mso-bidi-font-weight: normal;"><br /></b></div>
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Answer: We do recognise that like Canterbury, we are not going to be
able to achieve what we want overnight. Some work streams will take longer than
others. However in the meantime we are equipping ourselves with the lessons
learnt from the Canterbury project, as we have been able to meet with them and
apply this where appropriate to our work. <span style="mso-spacerun: yes;"> </span>We have also set ourselves some priorities to
deliver for 2017/18, which include:<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Providing
<b>more joined-up care closer to home</b>, through community hubs and
integrated teams working with groups of GPs, tailoring care to the needs of
their local communities.<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Making
it <b>easier for people to get urgent care when they need it</b>, including out
of hours.<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Improving
and simplifying care for <b>diabetes </b>and <b>musculoskeletal problems.</b><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Improving
and increasing access to <b>mental health services</b>, including for children
and young people.<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Improving
the prevention, diagnosis and treatment of<b> cancer.</b><o:p></o:p></div>
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<b><br /></b></div>
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<b style="mso-bidi-font-weight: normal;">Q5. How will the Bucks
ACS improve retention and recruitment of staff? What is the effect of the ACS
on the working conditions of staff, on their Terms and Conditions, GP surgery
& Pharmacy contracts etc.?<o:p></o:p></b></div>
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<b style="mso-bidi-font-weight: normal;"><br /></b></div>
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Answer: Staff will continue to be employed by the organisation they
currently work for and as such there will be no changes to their terms and
conditions or contracts as a result of Buckinghamshire becoming an ACS.<o:p></o:p></div>
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We hope that being an ACS will help to improve retention and
recruitment of staff in a number of ways.<span style="mso-spacerun: yes;">
</span>By working closer together across the system it will make it easier to
make sure we’ve got the right people in the right place at the right time. Job
satisfaction will increase as together we will be able to provide better care
in the community, at home or in hospital, helping people to stay
healthier.<span style="mso-spacerun: yes;"> </span>There will also be greater
career development opportunities for our people, as they will have the
opportunity to work in integrated teams or rotate across different health and
care settings. As one of the first ACS we believe the opportunity to get
involved in something that is exciting and innovative will also be an
attractive prospect for some. <span style="font-size: 12.0pt; line-height: 115%; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-language: EN-GB; mso-hansi-font-family: Calibri;"><o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;">Q6. What will be done to
improve access to Primary Care Services & GP services, especially in places
like High Wycombe and the rural parts of Buckinghamshire?<o:p></o:p></b></div>
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<b style="mso-bidi-font-weight: normal;"><br /></b></div>
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<span style="mso-bidi-font-family: Arial;">Answer: Improving access to
primary care services and GP services is central to NHS England’s Five Year
Forward View (FYFV) and General Practice Forward View (GPFV) and so is a key
part of much of the work at Aylesbury Vale and Chiltern CCGs.<span style="mso-spacerun: yes;"> </span>We also have a number of work streams in
place specifically designed to ensure the population of Buckinghamshire have
timely access to appropriate primary medical services. This work is being done
in the context of the development of an ACS for Buckinghamshire which
encourages partnership working across the whole health and social care system
and whose benefits are already positively impacting on improved access for
primary care services. <o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Arial;">NHS England
launched the General Practice Resilience Programme (GPRP) as part of the GPFV,
which is designed to secure sustainability of GP surgeries by tackling many of
the issues that are creating pressures on general practice and threatening the
viability of practices. A key part of the GPRP in Buckinghamshire is to
encourage practices to work together in clusters on a range of projects which
improve access to primary care services, for example, developing integrated
teams with a focus on integration with other primary care professionals
(nurses, pharmacists) or improved working with the voluntary sector, addressing
the needs of high intensity users of primary care, out of hours services and
A&E by better working with social services. We now have thirteen such
clusters beginning to form local plans across Bucks. <o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Arial;">In addition, GPRP
funding is being used to train care navigators in general practice. Care
navigators provide front of house signposting of patients to ensure they
receive the right care from the right healthcare professional, or alternatively
are able to access social care or services from the voluntary sector.<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Arial;">Many practices are
also using or developing alternative methods for patients to access primary
medical services such as on-line booking of appointments, Skype and telephone
consultations. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: Arial;">So that access to
primary care services in and out of hours is seamless for patients, we are also
in the process of commissioning extended access into primary care services
whereby patients will be able to book an appointment with a healthcare professional
8am to 8pm Monday to Friday.<span style="mso-spacerun: yes;"> </span>We will
also be looking at whether we need to commission this type of service at the
weekend (although experience from elsewhere suggests that routine appointments
for primary care services at the weekend are poorly utilised).<span style="mso-spacerun: yes;"> </span>We anticipate that 100% of the
Buckinghamshire population will be covered by this new service by March 2019.<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Arial;">The extent of the
work means that all residents of Buckinghamshire should see an improvement in
access to primary care services whether they live in a town or rural area. A
key part of cluster working is for practices to understand and plan for the
needs of their local area, including how different groups access services. As
the CCGs develop working as part of the ACS this locality focus will widen out
to other health and social care providers to create an integrated care system
with timely and appropriate access at its heart. <o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Arial;"><br /></span></div>
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<b style="mso-bidi-font-weight: normal;">Q7. Buckinghamshire has
already squeezed the local health economy and has, just about managed its
finances but there are now signs of stress in that a deficit is forecast for
this year.<span style="mso-spacerun: yes;"> </span>Is the ACS really just a
means to balance the books rather than improve quality of care? Buckinghamshire
has already made many changes to remain within the financial targets so what
other changes can be made in the way that hospitals deliver acute care more
efficiently?<o:p></o:p></b></div>
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<b style="mso-bidi-font-weight: normal;"><br /></b></div>
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Answer: Becoming an ACS is certainly not just a means to balance the
books although we are hoping that by working better together we can find ways
of delivering higher standards of care more cost efficiently.<span style="mso-spacerun: yes;"> </span>For Buckinghamshire Healthcare NHS Trust,
being part of an ACS is about how we can work with our partners in the system
to ensure the residents of Buckinghamshire stay healthier for longer - now and
in the future. Research shows that it is in the best interests of patients to
stay at home and receive treatment locally. We are working as a system to
achieve this, ensuring that acute care is there for those that really need it and
that all patients are seen at the right time, in the right place, first
time.<span style="mso-spacerun: yes;"> </span>We believe greater transparency
and openness between organisations – working towards a common goal – means that
we would reduce duplication and stop moving money around the system, instead
focussing on where the greatest support and investment is required. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Q8. There is a mismatch
between what senior managers/civil servants NHSE say and the views of those
providing and reviewing care on the wards, in outpatients & GP
surgeries!<span style="mso-spacerun: yes;"> </span>We need to bridge that gap –
what is being done to do so?<o:p></o:p></b></div>
<div class="MsoNormal">
Answer: We take the views of our staff extremely seriously and hold
regular informal and formal feedback sessions to understand any issues or to
hear suggestions for how we can improve things. <o:p></o:p></div>
<div class="MsoNormal">
We know that our staff have the solutions and so an
important principle for our ACS is for there to be strong clinical and staff
leadership, and that we actively involve and engage our patients and
communities to co-design future services. <o:p></o:p></div>
<br />A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-8485240223321900582016-12-24T20:28:00.000+00:002017-01-03T12:05:41.364+00:00The Workforce - the sixth priorityIn reality the Sustainability & Transformation Plans (STP) are all about reducing costs and in the NHS the cost of the wonderful staff is the biggest part of the overall cost to providing care. So any good planners will be taking a close look at staffing costs and performance.<br />
<div>
<br /></div>
<div>
Prioity 6 for Buckinghamshires STP is:</div>
<div>
<br /></div>
<div>
"Establish a flexible and collaborative approach to workforce."</div>
<div>
<br /></div>
<div>
Their initiative is:</div>
<div>
<br /></div>
<div>
"A shared workforce plan to support rotation of staff across organisations to increase quality of care and staff retention."</div>
<div>
<br /></div>
<div>
Motherhood and apple pie! The NHS locally has been talking about improving retention of staff for years yet it is still a problem. Staff morale is low. Staff select to wok in some areas and avoid others. Much of the care is provided by locum staff rather than permanent staff.<br />
<br />
In Buckinghamshire we have been short of A&E consultants for many years. GPs and Practice nurses, District Nurses and other specialities are also Report vacancies.<br />
<br />
So there suggestion is to share staff across different trusts. But as the nurse taking my Blood Pressure on her evening ward round said: "Every trust is in the same situation. Every day I get asked by an agency to work for more money"<br />
<br />
We need more permanent staff!<br />
<br />
We need to have enough staff to cover illness, holidays, training etc.<br />
<br />
There have rumours that across the STP, that is in Bucks, Oxfordshire & West Berks, £34m is to cut from staff budgets. This figure is in the published document but they do not explain how this will be achieved. As I type this on Christmas Eve they are trying to move an experienced nurse from my ward to one that does not a enough staff. This is dangerous. I do not know the outcome of the discussion.<br />
<br />
This is the reality of 21st century hospitals across the country.<br />
<br />
I do not think that this priority has a viable solution yet.</div>
<div>
<br /></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com1tag:blogger.com,1999:blog-4995595233579490141.post-61939956415924465742016-12-21T07:11:00.000+00:002017-01-03T12:04:17.175+00:00Improving Mental Health Services - the fifth priorityMental Health Services have to be specifically included in the Sustainability and Transformation Plan for Buckinghamshire. These services are already provided across Buckinghamshire by a range of providers, the main Trust covering both Bucks and Oxfordshire already.<br />
<br />
The priority for the Clinical Commissioning Groups (CCGs) is:<br />
<br />
"Mental Health development to improve the overall value of care provided."<br />
<br />
They describe this as :<br />
<br />
"Develop a network of providers of specialist mental health care across a larger footprint of STPs coordinating inpatient and community based services."<br />
<br />
What do I think this means?<br />
<br />
Well this is a guess but I reckon this means they want to increase the number of organisations that provide specific services. They want to do this across a bigger area than they do at present. This might mean that patients have to travel further for their mental health care.<br />
<br />
They realise that this means an increase in the number of organisations providing services and that they will be spread across the SE of England. This in turn means that this care needs to joined up and seamless. Good communications are essential as is an improvement in transport for patients across our poor road & transport network.<br />
<br />
Do they have the resources to coordinate the fragmented nature of this care? Will they be able to influence the Councils responsible for roads and public transport to improve the roads and buses?<br />
<br />
I am not sure!A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-47359426015756082372016-12-20T20:30:00.001+00:002017-01-07T17:34:29.380+00:00A recap on Buckinghamshire's STP - my thoughtsTen days ago I wrote a number of blogs before I went for the operation to remove the subcutaneous lump on my shoulder. I am just about over the GA and the couple of big bleeds post-op and somewhere close to normality. Well .... there is a short period each day when I can concentrate for more then 5 mins. Will that do for normal?<br />
<br />
Anyway I am now a cancer survivor.<br />
<br />
Hopefully, beds providing, I will heading to another hospital for a skin graft over the Christmas festivities. Such fun!<br />
<br />
Anyway....the blogs were about the Sustainability & Transformation Plan for Buckinghamshire (STP). I have tried to put in my terms an explanation of a summary document that our CCGs circulated at their recent set of public engagement events. They have tried to explain why they needed to develop the plan in association with local hospitals and the county council. They were very honest and said that it is because the increasing activity they will have to fund over the next five years will not be covered by the budget given to them by the Government.<br />
<br />
Can't be clearer than that. <br />
<br />
But sadly people still don't get it. Some people still believe the Government will throw money at the hospitals again. It didn't work in the past and it won't work this time.<br />
<br />
Tonight and tomorrow I will try to finish what I started last week. I have their final three priorities to finish.<br />
<br />
<br />
<br />
<br />A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-24775790213469639102016-12-12T10:07:00.000+00:002017-01-03T12:06:49.812+00:00Specialist services Maximising value - the fourth priorityThis one is a horror story!<br />
<br />
"Maximising value and patient outcomes from specialised commissioning"<br />
<br />
In CCG speak:<br />
<br />
"Identify opportunities for modifying pathways, standardising thresholds and increasing prevention to reduce spend and increase value"<br />
<br />
Well that is a mouthful! Lots of jargon and management speak in that statement.<br />
<br />
What do I think? I think it is all about reducing the cost of providing specialist care. This is the sort of care that is not done in our local hospitals. The sort of specialist treatment I am getting as I write this. I have to declare an interest here!<br />
<br />
There is always opportunities to improve the path us patients take through the system. We need to reduce the number of times we move between different parts of the system. This is a good thing. But it is not new and has been going on for years. But this must be done in partnership with the patients.<br />
<br />
The interesting phrase is 'standardising thresholds'. What do they mean? I think it means they want to make it more difficult for GPs to refer us to the specialist centres. At the moment many treatments are provided after the patient has ticked the boxes. The condition has to be severe enough for the CCG to fund it. Patients have to apply to the CCG for an 'individual funding review' when the CCG will look at each case before making a decision. This could be extended.<br />
<br />
I am not sure what they mean by increasing prevention and I assume this is linked to priority 1.<br />
<br />
As I said earlier it seems that the emphasis for this priority is on reducing cost.<br />
<br />A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-31337474388196642592016-12-12T08:55:00.000+00:002017-01-03T12:02:52.786+00:00Collaboration between the three acute trusts - the third priorityThe third priority is something to do with supporting the three acute hzospitals in the area to work together. <br />
<br />
"Collaboration of the three footprint acute trusts to deliver equality and efficiency".<br />
<br />
The CCGs description is:<br />
<br />
"Consoloidation of backroom services to ensure high quality and optimise cost effectiveness".<br />
<br />
What do I think this means?<br />
<br />
To be honest I have no idea but I will try to guess.<br />
<br />
Firstly what are the three acute trusts? I assume they mean the hospitals in Oxford , Reading and Buckinghamshire Healthcare (Wycombe & Stoke Mandeville Hospitals). At one time they were meant to be independent and in competition with each other. But things change and now it seems they have to work together to reduce costs.<br />
<br />
What do they mean by backroom services? I assume that they mean the services that we, as patients, do not see but are vital for quality care. One service that could be ripe for consolidation (or centralisation or merger) is pathology. These staff in this service do all the diagnostic tests, the blood tests and tissue samples, that help Doctors identify what is wrong with us.<br />
<br />
I used to work in pathology and I used to spend hours commuting on the train talking with a colleague about turning pathology into a large industrialised process. He later went on to work on doing just that and it can work at large scale as long as there is a good courier system and good communications between clinicians and pathologists.<br />
<br />
Other services such as personnel (AKA Human resources) and finance could also be consolidated.<br />
<br />
What we really want though, is more information and more detail. There are stories that they want to reduce the number of nurses as well as 'backroom' staff. But that seems crazy as we need more nurses not less for quality care. Of course the real question is can the three trusts work together for our benefit?<br />
<br />
So what does this mean for patients. Hopefully it will mean more money for our care but who knows!<br />
<br />A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-4704334968630000152016-12-11T20:37:00.002+00:002017-02-21T08:39:48.071+00:00Access to high quality care - the Second PriorityThe second priority area for the Clinical Commissioning Groups is:<br />
<br />
"Access to the highest quality Primary, Community and Urgent Care".<br />
<br />
They explain this in their words as:<br />
<br />
"Create robust out of hospital services operating from community hubs and coordinated by GPs to maintain independence of elderly and frail patients in their own homes"<br />
<br />
What do I think it means:<br />
<br />
They do not want so many elderly and frail people in expensive hospital beds. They want to improve the care and support that people receive in the community. There is a widely held opinion that people want 'care closer to their homes' and this is their way of providing that care.<br />
<br />
During 2016 there were a number of engagement events run by Buckinghamshire Healthcare NHS Trust called 'Your Community Your Care' where they asked our opinion on what sort of services could be provided outside the hospital. The Trust provides community services as well as acute services.<br />
<br />
The different groups of people from different areas of Buckinghamshire provided different thoughts on what they wanted. Most of us thought it was a good idea and should include a wide range of services either based on a building or as a virtual service.<br />
<br />
But at the moment there is no clear description of what a community hub would be like, or who would provide it and who would run it.<br />
<br />
For a few years before 1999 GPs offered a wide range of services from their surgeries but that came to an end when yet another of the redisorganisations of the NHS took place. District Nurses, Health Visitors, Midwives and other care workers were based around GP surgeries. Now they form teams and don't have the links they used to have with the GP surgeries. So recreating those teams with lots of different care staff all talking to each other and working together sounds like a good idea.<br />
<br />
There are already community hospitals in some parts of the county but not in the big population centres such as Aylesbury and High Wycombe. Will the CCGs be able to fund a base or will the community hub just be a virtual group in the big towns?<br />
<br />
Will the Trust be able to employ the right staff given the problems of recruiting healthcare staff in Buckinghamshire. The salaries are higher in London!<br />
<br />
This idea could work but it assumes that the GPs are willing to take on the extra role of coordinating the care?<br />
<br />
There should also be a big role for the voluntary organisations and charities who already provide a lot of support for the elderly.<br />
<br />
The CCGs hope this will reduce the attendance at A&E! But they have said that many times before and the numbers keep going up.<br />
<br />
We need to see the detail of this idea before we can say if it will really achieve the results they want.<br />
<b><br /></b>
<b>Added 21.02.2017</b><br />
<b><br /></b>
The problem with putting this idea into practice is the need to find the money to set up the new Community Hubs while at the same time keeping the patients in hospital. You cannot stop people going into hospital or transfer them out of hospital until the services are available in the community to look after them. <br />
<br />
As I understand it there is no extra funding for Buckinghamshire for this new serviceA stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-41890991265487531742016-12-11T19:33:00.001+00:002017-01-03T12:00:28.709+00:00From treatment to prevention - The first PriorityThe first of Buckinghamshire's priorities is to "Shift the focus of care from treatment to prevention".<br />
<br />
The Clinical Commissioning Group has describes this as:<br />
<br />
"Each and every clinical contact to include brief advice, supported by face to face, phone and web based behaviour change support. Build on existing asset based approaches."<br />
<br />
What I think it means:<br />
<br />
Everytime you see a Doctor, Nurse or other healthcare professional you will be told to eat sensibly (less?), take more exercise, drink less and to stop smoking. You will be encouraged to use an App or website to help us change our behaviour.<br />
<br />
Hopefully they will even support patient led groups & community groups to do the same. I asume these are what they mean by "asset based approaches" i.e using people to reinforce their messages.<br />
<br />
This seems a good idea but it will take a long time before any improvements are detected. The Public Health departments in the County Council should be funded properly to support this work. Will the council do that?<br />
<br />
I am not sure that busy Doctors and nurses will find the time in our appointments to keep nagging us.A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-8733483699951097362016-12-11T19:12:00.001+00:002017-10-21T11:47:40.125+01:00What is STP and what does it mean for Buckinghamshire?The STP is is short for Sustainability and Transformation Plan. However I guess that doesn't really help does it?<br />
<br />
Well it is really the last hope we have to save the NHS because the Government does not want to spend any more of our tax on our healthcare. So instead they want to split England into 44 regions and have told these regions to changes the way services are provided. Our region includes Oxfordshire, West Berkshire as well as Buckinghamshire. But really our plan is a Buckinghamshire plan.<br />
<br />
Apparently if we continue to carry out healthcare activity in the way we have been doing it over the last 20 years it will cost £107 million more over the next 5 years than we have money to pay for it. The costs will be much more than our income!<br />
<br />
The aims of the plan is to improve outcomes by 2020/21.<br />
<br />
The Bucks plan has seven priority areas.<br />
<br />
I will try to explain what they mean - but I cannot promise that my view is the correct one so I suggest you write and ask for the official version.<br />
<br />
The Famous seven are:<br />
<br />
"Shift the focus of care from treatment to prevention"<br />
"Access to the highest quality primary, community and urgent care"<br />
"Collaboration of the three footprint acute trusts to deliver equality and efficiency"<br />
"Maximise value and patient outcomes from specialised commissioning"<br />
"Mental health development to improve the overall value of care provided"<br />
"Establish a flexible and collaborative approach to workforce"<br />
"Digital interoperability to improve information flow and efficiency"<br />
<br />
You can see that the language is a bit 'management speak' and I will try to explain what I think each one means as best I can. I will do a separate blog for each priority.<br />
<br />
I write this on a ward in a specialist centre as I wait for my operation tomorrow. I hope that I will be able to complete all seven blogs over the next week as I recover.<br />
<br />
<br />
<br />A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-87124235296373299092016-04-09T04:41:00.001+01:002016-04-09T04:58:55.984+01:00Deja Vu - Moving care closer to the patient<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">Our local hospital, Buckinghamshire Healthcare NHS Trust (also the community health provider for the county) is holding a series
of public meetings about developing care closer to the patient. I guess the
need for this event comes from the publication last year of the ‘Five Year
Forward View’ that describes the strategy for the NHS over the next five or
more years.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> It is called <b>‘Your Community, Your Care – developing
community hubs’.<o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">The first meeting was held on Thursday evening in Thame.
Thame is a lovely market town on the Oxfordshire/Buckinghamshire border. There
were quite a few people there and the groups were buzzing with ideas on what
services should be provided in their community.
<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">A few common themes emerged.</span></div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="font-family: "arial" , sans-serif; font-size: 12pt; line-height: 115%;">The services should be truly multi-disciplinary and
joined up.</span></li>
<li><span style="font-family: "arial" , sans-serif; font-size: 12pt; line-height: 115%;">There should be rapid access.</span></li>
<li><span style="font-family: "arial" , sans-serif; font-size: 12pt; line-height: 115%;">It could support the promotion of good health &
signposting for solutions.</span></li>
<li><span style="font-family: "arial" , sans-serif; font-size: 12pt; line-height: 115%;">The ‘hub’ could act as a true community facility. </span></li>
</ul>
<br />
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">At the end of the meeting I was chatting to one of the
facilitators about the results of the meeting.
I said that the things that people said were not a surprise. Indeed
I said that we have known that this is what people want for many years and went
on to add that what we should be doing is getting on with developing these
community based services instead of having more public engagement meetings.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="font-family: "arial" , sans-serif;"><span style="line-height: 18.4px;">********</span></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">Now I am a sad person and I keep lots of documents and
stuff about health care, usually filed in heaps on the floor of the spare room.
I knew we had had similar meetings in the past so I went through the piles of
papers and found the feedback from a previous meeting (August 2010) on: <i>wait for it!<o:p></o:p></i></span></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">‘Developing
community healthcare services’<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">The views of the public then are the same as the views
expressed at the meeting on Thursday. In fact the hospital could save itself
the trouble of writing a report on the meeting and just recycle the old one
from 6 years ago.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: center;">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><i>Amazing!<o:p></o:p></i></span></div>
<div class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal" style="text-align: center;">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><b>Not!</b><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">*******</span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">They are holding another five of these meeting in the
next few weeks. What a waste of time.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">The question is why have they not developed these
community hubs?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">Now I am guessing here but perhaps the reason that they
failed to do this six years ago and a distinct risk to doing it now, is the
fact that the various providers of services cannot agree to share the scarce
resources i.e. staff and budgets.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">They talk about joined up working and integrated care but
still won’t take the risk with the money.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">All the talk at the meeting was about care. Not ‘health’ care or ‘social’ care but
‘care’. As we get older, and I am a
pensioner now so in the next few years that will be me, we need care and
support. It becomes harder to distinguish between health care and social care
as we become frailer and less able to cope on our own.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">So until we get the Directors of Finance and the CEOs to
come to these meetings and tell us that they will share the resources we need
to have our community hubs I cannot see these ideas being implemented.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">I wonder how many more times I have had these Deja Vu moments?<o:p></o:p></span></div>
</div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-78616855928649618342016-04-08T10:30:00.001+01:002016-04-09T04:52:18.186+01:00NHS MSCP Vanguard funding <div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">The NHS has to work differently in order to provide good
quality services for all within the current funding limits. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">In different parts of England there are lots of different
models being tried out to see which works best.
These are called Vanguards and are receiving extra funds to transform
the health care systems locally.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">I thought I would try to find out how much extra funding
they were receiving. It was a harder job
than I thought. In the end I used the
Freedom of Information Act to obtain the information from 14 Vanguard who were
piloting one type of model. <b>The Multispecialty Community Provider (MSCP)
model of care.<o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://www.england.nhs.uk/ourwork/futurenhs/new-care-models/community-sites/"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">https://www.england.nhs.uk/ourwork/futurenhs/new-care-models/community-sites/</span></a><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">It was difficult finding out who to approach for the
financial information, sometimes I got it right first time but for others I had
to go through several organisations before getting to the right person.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Vanguard<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Population<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Funding £ (2015/2016)<o:p></o:p></span></b></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Calderdale Health & Social Care Economy<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">200,000<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">150,000<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Erewash MSCP<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">No reply<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Fylde Coast Local Health Economy<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">330,000<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">4,300,000<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Modality (was Vitality) <i>(Birmingham)</i><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">No reply<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">West Wakefield Health & Wellbeing<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">153,000<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">2,829,000<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Better Health & Care for Sunderland<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">284,000<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">2,305,000<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dudley MSCP<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">315,000<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">2,700,000<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Whitstable Medical Practice<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">169,806<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">1,850,000<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Stockport Together<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">300,000<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">3,900,000<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Tower Hamlets Integrated Provider
Partnership<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">284,000<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">2,990,000<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Better Local Care <i>(Hampshire)</i><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">220,000<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">6,960,000<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">West Cheshire Way<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">255,000<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">4,900,000<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Lakeside Surgeries<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">No reply<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.65pt;" valign="top" width="357"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Principia Partners in Health <i>(Nottinghamshire)</i><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Not received<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal">
<span style="font-family: "arial" , sans-serif; font-size: 12pt; line-height: 115%;"><br />There were 14 Vanguards and I received 11 responses. </span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">One
Vanguard had only received a small initial payment and one had not received any
funding at the time they responded and I excluded them from my analysis.. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt; line-height: 115%;">So for the remaining 9 Vanguards the funding varied from £31 a head to £8 a head.<o:p></o:p></span></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<br /></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-26417167220088707192016-03-24T19:26:00.000+00:002016-04-09T04:49:27.059+01:00General Practice - Appointments, Capacity and Choice<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Talk to
anyone about the thing that irritates them about General Practice and the first
thing they mention is appointments. It’s not just the patients! The staff also
feel the pressure on appointments.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">How can we
increase capacity in General Practice so that there are enough appointments
when there are a falling number of GPs?
What is ‘enough’ appointments anyway?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">There are
those who say we should also increase choice for patients in where they go for
primary care – “more surgeries” is the cry.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;">The digital solution<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">There are
several websites or Apps, such as </span><a href="http://askmygp.uk/"><span style="font-size: 14.0pt; line-height: 115%;">http://askmygp.uk/</span></a><span style="font-size: 14.0pt; line-height: 115%;"> that allow people to enter their
symptoms and answering some questions allows the GP to work out the best way to
help. These may advise the patient as to
who is best p[laced to help them. This may create some spare capacity so that
those who need to see a GP, such as people with complex needs, can do so.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;">The ‘do it on the phone’ solution</span></b><span style="font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Instead of
seeing a GP or other healthcare professional the patients the consultation will
take place on the telephone or via Skype or some form of webcam interaction or
by email. There are a number of solutions available to manage phone calls such
as </span><a href="http://gpaccess.uk/"><span style="font-size: 14.0pt; line-height: 115%;">http://gpaccess.uk/</span></a><span style="font-size: 14.0pt; line-height: 115%;"> & </span><a href="http://www.digitallifesciences.co.uk/"><span style="font-size: 14.0pt; line-height: 115%;">http://www.digitallifesciences.co.uk/</span></a><span style="font-size: 14.0pt; line-height: 115%;"> <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Both of the above solutions could also be considered the ‘managing the demand side’ solutions.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;">The Changing traditional General
Practice or more GP surgeries solution<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;">(‘more of the same’)<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">This
solution is about increasing the number of GP surgeries so increasing the
number of appointments and increasing choice for patients. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">So how do
you go about developing a new surgery? You need to raise the cash to buy or
rent a suitable building. You need to recruit the relevant staff. That means a
full multi-disciplinary team to provide a 21<sup>st</sup> century service. The
cost of a building for 6000 patients could be around £1.5 million but could be
more if an extended team is required.</span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;"> <o:p></o:p></span><span style="font-size: 14pt; line-height: 115%;">This
investment has to come from somewhere.</span><span style="font-size: 14pt; line-height: 115%;"> </span><span style="font-size: 14pt; line-height: 115%;">There
is the Prime Minister Innovation Fund (</span><i style="font-size: 14pt; line-height: 115%;">now
with a smart new name</i><span style="font-size: 14pt; line-height: 115%;">) that was for existing practices if they developed 7
day working. There has not been any funding for new builds from central
government for the last 25 years or so. If there is a new housing development
and if the local planning authority is up to the mark such a new building could
come from ‘planning gain’ and built into the cost of the development. However
the developers would only build the bare minimum – based on 1990’s requirements.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">However
there is still the problem of revenue costs which has to currently come from
the NHS. Unless, of course, there is a change in the views of the public on
private healthcare or health insurance.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Finally
there is the problem of recruiting the staff. GPs and nurses are hard to recruit
or retain at the moment.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;">The nuclear solution<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">One way of
increasing appointments with a GP is to do the reverse. Patients will only see a GP after they have
been seen by another health care professional, (a nurse, a pharmacist or an
emergency care professional). They would
refer patients onto a GP as appropriate in the same way as a GP refers to a
consultant. Thus the GPs would see fewer
patients.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;">Other solutions<o:p></o:p></span></b></div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="font-size: 14pt; line-height: 115%;">Reduce unmanageable
& unsafe workload</span></li>
<li><span style="font-size: 14pt; line-height: 115%;">Improve
perception of General Practice as a career option for junior doctors &
nurses.</span></li>
<li><span style="font-size: 14pt; line-height: 115%;">Reduce
administrative & regulatory burden.</span></li>
<li><span style="font-size: 14pt; line-height: 115%;">Return to
self-management of minor illness.</span></li>
</ul>
<br />
<div class="MsoNormal">
<b style="font-size: 14pt; line-height: 115%;">There is a final solution </b></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">There could be
real and meaningful investment to restore the percentage of the
NHS budget spent on General Practice back to the 10% it used to be.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt; line-height: 115%;">So how will these solutions increase
choice and capacity?<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Really the
only solutions to do that are ‘the more of the same’ solution of increasing
traditional general practice by increasing the number of practices. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">This is
highly unlikely given that there is no investment in new building and real
problems in recruiting new GPs. If the
government does not invest will private investors take that role? Again, in my opinion, I think that is unlikely
as there is no profit to be made from general practice at present.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Would a community
enterprise or other not for profit organisations invest in general practice? That is an interesting question.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">So sadly I
can see no way to increase choice for patients.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Similarly
the only way for general practice to survive is to manage demand rather than
increase supply.</span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">#GPincrisis<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Urgent prescription for general practice</span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<br /></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-6233023859113056022015-10-15T13:04:00.001+01:002015-10-15T13:04:55.665+01:00Impact of a shortage of GPs<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;">In many parts of the country GP surgeries are having trouble
recruiting Doctors and Practice Nurses. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;">What impact is this having on patients and the care they
receive?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;">My guess:<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;">There will be a shortage of appointments, so
patients will have to wait longer to see a GP.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;">Telephone lines will be even busier so it
will be harder to contact the surgery.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;">Patients will be asked (forced) to see someone
other than a GP. This may be a Practice
Nurse or a pharmacist. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;">More locum staff may be employed.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;">Practices may close completely.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;">Surgeries will close their lists to new
patients.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;">Branch surgeries will be closed.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%;">New patients will have to join another practice which may
be some distance away from their home.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">This will put
pressure on these other practices as they get more patients joining the
practice and the cycle continues.</span></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-43675873701287568792015-06-04T19:59:00.000+01:002015-06-04T19:59:59.916+01:00Don't just talk - do something. <div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Have you
ever talked about your GP surgery over dinner, sitting in a café, standing in
the checkout at the supermarket….?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Well you are
not alone!<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">A Million
people a day use their GP surgery and most of those will have something to say
about the experience.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Most of
those experiences are good.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">However
sometimes us patients have ideas about how to make the experience of talking
with a GP or practice nurse better.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">There can be
problems with the phone service, making appointments isn’t always easy, seeing
your own GP can mean waiting weeks, no privacy at the reception desk, access
can be difficult for those with disabilities and as for car parking…!<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">So instead
of talking about things on your own – join your Practice Patient Participation
Group (PPG) and do something about them.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">A patient
participation group is a bunch of volunteers who want to make a
difference. They work with the practice
to gather information from patients and to make suggestions about improvements.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">They look at
the surgery and ask:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-size: 14.0pt; line-height: 115%;">What works well?<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-size: 14.0pt; line-height: 115%;">What works less well?<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-size: 14.0pt; line-height: 115%;">Are there services that are not provided but would benefit
patients?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">They also
run an annual patient survey, hopefully the questions are set by the patients
not the surgery.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Sadly
General Practice is going to have to change. Being part of your PPG is one way
you can help to make sure we keep the best bits of General Practice<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Your voice
on its own is very quiet.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">But the
voice of the many people in the PPG is much louder and will be listened to.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Please join
your Practice Patient Participation Group.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 115%;">Ask at
reception or look on the practice website.
Maybe there is a social media page?<o:p></o:p></span></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-49359913141572672352015-04-27T21:48:00.001+01:002015-05-02T10:16:36.317+01:00Has General Practice passed the tipping point?<br />
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif;">Is this the future?</span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Unless something dramatic or revolutionary happens at the
Department of Health after the election have we seen the end of General
Practice as we know it?<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Here are three possible scenarios.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; text-align: center; text-indent: -18pt;"><b>Scenario 1.</b></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; text-align: center; text-indent: -18pt;"><br /></span></div>
<div class="MsoNormal">
<span style="text-align: center; text-indent: -18pt;"><span style="font-family: Arial, Helvetica, sans-serif;">GPs become consultants in the management of patients with complex and unsorted symptoms. Everything else i.e. minor illnesses, uncomplicated long term conditions, social issues, work related problems, etc. will be managed by other members of the Primary Care Team: Pharmacists, advanced nurse practitioners and physician assistants.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpMiddle">
<span style="font-family: Arial, Helvetica, sans-serif;">The GP will assess, investigate and sort
out patients presenting with undifferentiated symptoms and look after patients
with multiple co-morbidities and complex needs.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle">
<span style="font-family: Arial, Helvetica, sans-serif;">Patients will no longer have direct access
to a GP.</span></div>
<div class="MsoListParagraphCxSpMiddle">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoListParagraphCxSpMiddle">
<span style="font-family: Arial, Helvetica, sans-serif;"><b>Scenario 2</b></span></div>
<div class="MsoListParagraphCxSpMiddle">
<br /></div>
<div class="MsoListParagraphCxSpMiddle">
<span style="font-family: Arial, Helvetica, sans-serif; text-indent: -18pt;">GPs will become disease specific consultants
working in the community.</span><span style="font-family: Arial, Helvetica, sans-serif; text-indent: -18pt;"> </span><span style="font-family: Arial, Helvetica, sans-serif; text-indent: -18pt;">All acute
patients will be managed by pharmacists, NHS 11, nurse clinics & physician
assistants.</span></div>
<div class="MsoListParagraphCxSpMiddle">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 7pt; font-stretch: normal; text-indent: -18pt;"> </span><span style="font-family: Arial, Helvetica, sans-serif; text-indent: -18pt;">Patients will no longer have direct access to a
GP.</span></div>
<div class="MsoListParagraphCxSpMiddle">
<span style="font-family: Arial, Helvetica, sans-serif; text-indent: -18pt;"><br /></span></div>
<div class="MsoListParagraphCxSpMiddle">
<span style="font-family: Arial, Helvetica, sans-serif; text-indent: -18pt;"><b>Scenario 3</b></span></div>
<div class="MsoListParagraphCxSpMiddle">
<span style="font-family: Arial, Helvetica, sans-serif; text-indent: -18pt;"><br /></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;">Co-payments. Patients will pay for their primary
care, perhaps with government paying for a set number of consultations per year.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Personally I do not think that civil servants and politicians do
‘revolutionary’!<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<br />
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">I am sure there are others scenarios. Please suggest some.</span><o:p></o:p></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-53092709523461939652014-09-29T15:29:00.000+01:002014-09-29T15:34:07.274+01:00Possible models of General Practice<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Any number of organisations have looked at the possible
models of General Practice in England (see below for some recent examples). They have produced lots of glossy pages
describing the issues and possible models.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">So we thought we would produce a short list of the possible
ways that a local community could get its GP service provided. In no particular order.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">“The
Status Quo”.</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> The
partnership option.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Under the current circumstances, unless the government
changes its attitude this is not a realistic option. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">A Salaried
service with GPs.<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Through
Foundation Trust Hospital – Vertical integration.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Through
private companies i) groups of GPs, ii) multi-national companies iii) venture
Funds etc.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 54.0pt; mso-add-space: auto;">
<br /></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">A
nurse led service <o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">This would probably be with GPs as community
specialists/consultants at a distance. (There would be no doctor as first point
of contact, no legal right to a GP).<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Walk
In centres.<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Patients would be triaged and referred onto the ‘appropriate’
Healthcare provider.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">NHS111<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">All access to healthcare would be through NHS111 call
centres<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Federation<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">GP practices merge or federate to form a large
organisation (Management & Admin merged to save money & probably staff
used across all sites rather than based on a specific site).<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Investment
by Government<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">You never know it might happen. The government realises
that the current system is the envy of the world and invests to support the
development and innovation that has taken place over the last 30 years<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">I may look at the advantages and disadvantages of these
options at a future date.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Further
reading</span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Nuffield Trust<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><a href="http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130718_securing_the_future_revised.pdf">http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130718_securing_the_future_revised.pdf</a>
<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">RCGP<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><a href="http://www.rcgp.org.uk/campaign-home/~/media/Files/Policy/A-Z-policy/The-2022-GP-A-Vision-for-General-Practice-in-the-Future-NHS.ashx">http://www.rcgp.org.uk/campaign-home/~/media/Files/Policy/A-Z-policy/The-2022-GP-A-Vision-for-General-Practice-in-the-Future-NHS.ashx</a>
<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Kings Fund<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><a href="http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/commissioning-and-funding-general-practice-kingsfund-feb14.pdf">http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/commissioning-and-funding-general-practice-kingsfund-feb14.pdf</a>
<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">NHS England A call to action <o:p></o:p></span></div>
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><a href="http://www.england.nhs.uk/wp-content/uploads/2014/03/emerging-findings-rep.pdf">http://www.england.nhs.uk/wp-content/uploads/2014/03/emerging-findings-rep.pdf</a>
<o:p></o:p></span></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-22351854888965375842014-04-09T17:43:00.002+01:002014-04-09T17:45:04.266+01:00How have the public influenced commissioning of healthcare in Aylesbury?<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">I asked my local Clinical Commissioning Group (Aylesbury Vale CCG) a question about providing examples of how the public has influenced commissioning in advance of their board meeting in public on Thursday April 10th.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Here is the reply from their clinical leads:</span></div>
<div class="MsoNormal">
<i><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial, Helvetica, sans-serif;">My Question: Can you please give examples of where the
voice, opinions and experiences of patients and the public has influenced
decisions made when commissioning services?<o:p></o:p></span></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Christine Campling:<o:p></o:p></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;">We did extensive public consultation on the inter
mountain project by focus groups and questionnaires. There was full support for
changing the range of options on outpatients to a mixture of face to face,
telephone and Skype like consultations. We are currently running questionnaires
on pain clinic projects, as we are redesigning the pain pathway.<o:p></o:p></span></div>
<div class="MsoPlainText">
<br /></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;">Stuart Logan:<o:p></o:p></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;">We have met with Patient Groups in the South Locality for
their input into Live Well particularly the Haddenham Patient Participation
Group.<o:p></o:p></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;">We are involving Diabetes UK in the diabetes service
redesign. They will have patients at the Stakeholders meeting in May inputting
into the redesign process from day 1.<o:p></o:p></span></div>
<div class="MsoPlainText">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Juliet Sutton:<o:p></o:p></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;">When they were doing a full review of Occupational
Therapy and Speech & Language Therapy services for children, they went out
and spoke to a lot of parents of children using the service. Parents
wanted shorter waiting times, a more responsive service, improved technology
and access to health professionals in settings closer to them e.g schools and
children's centres. All these views were incorporated into the new service
design and there have been great improvements in the service since then. The
children's physiotherapy service is currently under review and once again the
views of parents and carers are being taken into consideration when making
recommendations for service improvements.<o:p></o:p></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;">We are currently undertaking a review of the services
provided for children with complex needs/disabilities. Parental feedback is a
large part of this process and their comments are being taken very seriously
when planning future more integrated care. Single point of access is a
recurrent theme from the feedback we have received and this will be one of our
main objectives with future recommendations.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Lesley Munro-Faure:<o:p></o:p></span></div>
<br />
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;">commissioning plans are driven by localities and each
locality has members of the public sitting on them who input into all the
decisions that are made.</span><o:p></o:p></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;"><i>My comments: </i></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;"><i>I had hoped that I might get a list of things the patients & public has said or suggested and a another list showing what the CCG had done as result of the comments from patients. </i></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;"><i><br /></i></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;"><i>I had also hoped that I would get examples showing actual changes in how services are commissioned instead I seem to have got examples of consultations & involvement in redesigning services. And there is nothing wrong in seeing examples of patient participation in redesign.</i></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;"><i><br /></i></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;"><i>There are examples of good work especially with the work done by the therapy services for children.</i></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;"><i><br /></i></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;"><i>The last paragraph of their reply puzzles me. There are three localities in the CCG and I know that one of them does include members of the public in the group. But the other two locality groups consist of clinicians only. Anyway this last paragraph does not give examples of how the public have influenced commissioning.</i></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;"><i><br /></i></span></div>
<div class="MsoPlainText">
<span style="font-family: Arial, Helvetica, sans-serif;"><i>I will follow up this answer at the board meeting and I will blog about it if anything new is mentioned.</i></span></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-67603594834142266652014-03-25T20:01:00.000+00:002014-03-25T20:03:24.469+00:00Better Care Fund - Mission Impossible?<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The government having just made the biggest
re-organisation of the NHS is now insisting that local health and social care
economies now embark on another! <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Health and Wellbeing Board which only came into existence
12 months ago are now developing plans to use the Better Care Fund. This fund is drawn from existing funds from
health and social care commissioners. The total could be around £4 billion for
England and in Buckinghamshire the fund will be nearly £100 million. This is
three times the size of the fund that other areas are implementing! Are they being too ambitious?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">What will this fund do?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The Better Care Fund is to be used to integrate health
and social care services, especially for older people. It is hoped that this integration will reduce
costs and improve the quality of care (in that order).<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Many of us have asked for a closer integration of health
and social care and so we should be welcoming this new work. But should the timer scale for developing the
project be longer than 12 months? Can
these new organisations, barely out of nappies, successfully implement such a
big change in the way services are commissioned?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> Patients,
especially those with long term conditions & the elderly need care and support and
they get that support from many different agencies – the NHS, Social services,
the voluntary sector, the private sector, families and friends to name a few. Currently
some care is called health care and some is called social care. But patients don’t
really care what it is called. Or who commissions & funds it. What they want is for it to be provided
without any gaps, when and where they need it. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">They don’t want to have to go to one lot of people for
one sort of care and then go through another assessment for more support! They just
want to go to one point to ask for help.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">So this Better Care Fund sounds as if it a good idea. But
some say it will not save money and will not improve services. They say there is no evidence that it will
achieve these objectives. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">I am also concerned that locally the public and patients
have not been involved in the design of this new service. As usual we will be involved and consulted
with in the middle of the process rather than at the beginning. Who is to carry out that involvement? It is Healthwatch Buckinghamshire who are
virtually unknown to the population of Buckinghamshire. Will they be able to carry out a meaningful
engagement with the public, let alone real involvement in the design of the new
service? <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Finally who is going to manage this fund, who will monitor
the quality (and quantity) of the care? Who will be accountable? <o:p></o:p></span></div>
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<br /></div>
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">It’s a mystery!<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">You can see the latest update on Buckinghamshire Health and Wellbeing Board's plans <a href="http://democracy.buckscc.gov.uk/documents/s48089/Buckinghamshire_Integrated%20Care%20for%20Older%20People_Case%20for%20Change_v1%20021.pdf" target="_blank">here</a></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><a href="http://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP97_Financial_mechanisms_integrating_funds_healtthcare_social_care_.pdf" target="_blank">Here</a> is a review of the evidence recently published by
the University of York which suggests that these schemes should be rolled out
cautiously and may increase overall costs.<o:p></o:p></span></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-57084007233223294352014-01-08T18:37:00.002+00:002014-01-08T18:40:41.818+00:00It’s the patient experience, stupid!<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">I have
always thought that the main role of local Healthwatch was to collect the experiences
of patient using the health and social care services.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">But one
of their board members is quoted in the minutes of their November board meeting
as saying<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;"> “</span><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">Healthwatch Bucks could make a business case for
the integrated collection, analysis & reporting of patient feedback across
health and social service provision in Buckinghamshire”.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal" style="background: white; mso-line-height-alt: 11.25pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><a href="http://www.healthwatchbucks.co.uk/sites/default/files/board_minutes_11th_november.pdf">http://www.healthwatchbucks.co.uk/sites/default/files/board_minutes_11th_november.pdf</a><span class="MsoHyperlink"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="background: white; mso-line-height-alt: 11.25pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">So why does this board member think Healthwatch Bucks
needs to make a business case to do what it is contracted to do anyway? By using the words ‘business case’ he is
suggesting, in my opinion, that they should seek funding to do this job. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">They should be doing it now as part of their primary
function, not asking for more funds!<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">I
wonder if he has seen what Healthwatch Buckinghamshire says on its own website.
<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">This
statement is included as part of their ‘What we do’ section on the Healthwatch
Buckinghamshire website<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">“Collect data and stories about the good and the bad,
so we can use evidence based criteria to influence commissioning and policy.”<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">They
expand on this theme in their ‘What will Healthwatch do’ section of the
website:<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; margin-left: 36.0pt; mso-line-height-alt: 11.25pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">“….seek
the views of people about their needs for, and their experiences of, local care
services.”<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; margin-left: 36.0pt; mso-line-height-alt: 11.25pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">“Examine
the quality of local health and social care services</span><span style="color: #00506b; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">.”<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; margin-left: 36.0pt; mso-line-height-alt: 11.25pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">“Make
the views of local people known, and reports and recommendations about how
local care services could or ought to be improved, to people responsible for
planning, providing, managing or scrutinising local care services.”<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; margin-left: 36.0pt; mso-line-height-alt: 11.25pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="background: white; mso-line-height-alt: 11.25pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"><a href="http://www.healthwatchbucks.co.uk/">http://www.healthwatchbucks.co.uk/</a></span><span style="font-family: Arial, sans-serif; font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; mso-line-height-alt: 11.25pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="background: white; mso-line-height-alt: 11.25pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Even the CCG has
something to say on the issue:<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; mso-line-height-alt: 11.25pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">In their draft
paper on the Review and Development of our (AVCCG) Commissioning Intentions
they say: <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<i><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">“(the CCG will)</span></i><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;"> Work closely with Healthwatch to expand the
feedback we receive on patient experience from direct observation and feedback
from patients, clinicians and the public including those from hard to reach
communities. “.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><a href="http://www.aylesburyvaleccg.nhs.uk/wp-content/uploads/2013/10/GB-2013-10-4b.pdf">http://www.aylesburyvaleccg.nhs.uk/wp-content/uploads/2013/10/GB-2013-10-4b.pdf</a>
<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">It is high time Healthwatch Buckinghamshire stopped
talking and got on with its primary function. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Go out and collect the experiences of patients and
carers of health and social care service provision.<o:p></o:p></span></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-76235784442732135492013-10-11T23:00:00.001+01:002013-10-11T23:03:19.616+01:00A&E issues in Buckinghamshire<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">There are a lot of unhappy people in the south of
Buckinghamshire, especially in the High Wycombe area. They want their A&E and other hospital
services back! The sad truth is that this is unlikely to happen.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">As I have written about previously<i> (What is happening to my hospital)</i> the A&E service
closed down in 2005 and first there was the Emergency Medical Centre then in
2012 there was the Minor injuries and Illness Unit (MIIU). This must have felt like a downgrading
of services each time there was a change.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The authorities did not do a good job in explaining the
reasons for these changes to the residents of High Wycombe and the surrounding area.
<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">As part of their inquiry into the actions being taken as
a result of the Keogh inquiry into Buckinghamshire Healthcare NHS Trust the
county Council health and social care select committee is going to examine the
provision of A & E services. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">I am predicting that they will say something along these
lines:<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">Better facilities for A & E should be provided at
Stoke Mandeville Hospital.</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">More permanent</span><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">
</span><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">Consultants, junior doctors and nurses in A&E are needed at Stoke Mandeville Hospital.</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">Better parking is needed </span><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;"> </span><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">at Stoke Mandeville Hospital.</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">Better transport links (roads and public transport)
between High Wycombe and Aylesbury are needed.</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">An effective and regular publicity campaign about the
appropriate service to use (A&E, MIIU, Pharmacies, GP surgeries etc.) is
needed.</span></li>
</ul>
<br />
<div class="MsoNormal">
</div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">They may use a few more words though. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">See press articles<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><a href="http://www.bucksfreepress.co.uk/news/healthnews/10718683.Campaigner_calls_hospital_crash_response__a_joke_/">http://www.bucksfreepress.co.uk/news/healthnews/10718683.Campaigner_calls_hospital_crash_response__a_joke_/</a><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">See Steve Baker MP for High Wycombe Blog<o:p></o:p></span></div>
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><a href="http://www.stevebaker.info/2013/10/farce-at-wycombe-hospital/">http://www.stevebaker.info/2013/10/farce-at-wycombe-hospital/</a><o:p></o:p></span></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-20404393998728512562013-10-11T17:34:00.000+01:002013-10-11T17:39:35.194+01:00Communication<h4>
<span style="font-family: Arial, sans-serif; font-weight: normal;">I love this quote:</span></h4>
<div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif";">Communication
is primarily a function of trust, not of technique. When the trust is high, communication is
easy, it is effortless, it is instantaneous, it is effective - it works.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif";">But when the
trust is low and the emotional bank account overdrawn, communication is
exhausting, it is terribly time consuming and its like walking in a minefield.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif";"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif";"><i>I wish I knew who said it? so </i></span><i style="font-family: Arial, sans-serif;">I googled it and ..........</i><br />
<br /></div>
</div>
<div class="MsoNormal">
<o:p></o:p></div>
<em style="background-color: white; color: #333333; font-family: 'Arial Narrow', Arial, 'DejaVu Sans', sans-serif; font-size: 16px;"> Stephen Covey, from </em><span style="background-color: white; color: #333333; font-family: 'Arial Narrow', Arial, 'DejaVu Sans', sans-serif; font-size: 16px;">The 7 Habits of Highly Effective People</span><br />
<div class="MsoNormal">
<o:p></o:p></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-76979300880711353652013-09-27T19:40:00.001+01:002013-09-28T14:45:48.196+01:00Conversations between patients and hospitals<br />
<br />
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">Some hospitals and the newly created
Clinical Commissioning groups are finding it difficult to engage in a
meaningful and effective way with patients and the public. </span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><o:p></o:p></div>
<div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: 12pt;">These are my thoughts on how they could
hold a conversation with the public rather than 'engage' with them.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Go out to
the people – don’t expect them to come to meetings. It’s the same
old faces, like me who go to public meetings.</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Use
language suitable for all</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Keep it
simple</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Keep
events small and short</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Don’t
give too much information at any one time</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Leave
time for reflection</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Be
prepared to repeat and revisit issues</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Hold a
conversation</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Use
patient leaders/champions</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Feedback
is essential. Explain how the input from patients has been used and has
influenced change</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Be
informal, don’t lecture/broadcast.</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Use staff, not managers/executives (?)</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Be bold,
take risks, do something different.</span></li>
<li><span style="font-family: Arial, sans-serif; font-size: 12pt;">Social
media is very powerful but it is a conversation. Those of us who use twitter get
irritated if all we get are broadcasts and publicity messages. </span></li>
</ul>
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<o:p></o:p></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
<br />
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<o:p></o:p></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-21365470099153136362013-09-27T19:17:00.000+01:002013-09-27T19:17:40.187+01:00My questions at the AGM (Buckinghamshire Healthcare NHS Trust)<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">In the previous blog I gave my own highlights of the
Buckinghamshire Healthcare NHS Trust AGM. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">After the Chief Executive gave her presentation and the
finance director gave his summary of the financial situation we heard from the
leaders of the emergency surgery teams. They described how they had changed the
service, what is called reconfiguration, and how the new service was producing
better outcomes for patients & reducing mortality rates. Good news.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">At the end of the event there was time set aside for the
public to ask questions. I have no idea
how many members of the public were present but I was virtually the only person
who asked questions. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Why is it that people don’t ask questions in formal board
meetings? I reckon most people know the
answer to that one.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">I asked a couple of questions: <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The first was about the campaign to restore an A&E department
to the High Wycombe Hospital site. A petition with 16,000 signatures has been
organised.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<i><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">There
are 16,000 people in the south of the county who believe that there should be
an A & E on the Wycombe Hospital site.<o:p></o:p></span></i></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<i><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Can
I ask that the Communications teams from the Clinical Commissioning Groups and the trust remind us, on a
regular basis, about the good clinical, organisational and financial reasons
why, in the present circumstances, there can only be one A & E in the
county?<o:p></o:p></span></i></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">This is an on-going issue for those who live in High
Wycombe. The A&E department was
closed in 2005 after a public consultation and replace with a minor injuries
type of service.<o:p></o:p></span></div>
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<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">As we know from other examples of such closures the local
population is incredibly loyal to their local hospital. MPs too! So the story
here is how to sell the difficult and complex reasons, hopefully evidence
based, for such closures. <o:p></o:p></span></div>
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<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">In my opinion the only way to tell the story is to keep
it simple and be persistent.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">However the audience was asked what else could be done to
explain the reasons why there are only resources for one A&E department in
the hospital.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">My suggestion is that the leaders of the campaign should
meet with senior clinicians and managers (and the commissioners) to have an informal,
facilitated discussion and look at the evidence. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">As for how to improve the conversation between the
hospital executives and the patients is something to explore in another blog.<o:p></o:p></span></div>
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<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">*****************<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The second question I asked was about the way they manage
complaints.<o:p></o:p></span></div>
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<br /></div>
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<i><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Can
I ask that the board measures its performance on managing complaints by using
the following as outcome measures?<o:p></o:p></span></i></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><i><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; line-height: normal;">
</span></span></i><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Is
the complainant satisfied at the end of the process<o:p></o:p></span></i></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><i><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; line-height: normal;">
</span></span></i><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> has the trust learnt from the complaints <o:p></o:p></span></i></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><i><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; line-height: normal;">
</span></span></i><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">has
the trust acted on the learning.<o:p></o:p></span></i></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Normally the first thing that the board reports is that
they replied to people within the required time. This is important of course,
but I reckon that most people would say the best test of a good complaints
service is: was I happy with the result?<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> I hope that the
trust may consider that a different approach will improve the way people think
about the way complaints are managed. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">They expressed some interest in this approach and said
that they are trying to do something like this.
They have been contacting people by telephone after the complaint has
been closed, especially complex complaints. But they have not been recording
this activity. It sounds as if they are looking to improve the experience of
complaining.<o:p></o:p></span></div>
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<br /></div>
<br />
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">They did say that they get many more accolades than complaints.
This is good to hear. <o:p></o:p></span></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0tag:blogger.com,1999:blog-4995595233579490141.post-59884747493010597762013-09-25T19:29:00.001+01:002013-09-25T19:29:55.378+01:00Buckinghamshire Healthcare NHS Trust AGM 2012/13<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">I realise that I have not written anything for my blog
for a long time. It has been a good
summer so I have been otherwise engaged on holiday and working on my allotment.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">I have just come back from our local hospital trust
AGM. This is a trust under special
measures and heavily involved in the Jimmy Savile inquiry. Yet all is not lost
–there is good news as well.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">There was not a single case of MRSA during the year
2012/2013. They recorded their lowest
number of C Diff infections ever. – down by 50%.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The Hyper-acute Stroke Unit is the best in the region
according to the Royal College of Physicians.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The hospital and the spinal injuries centre were at the
centre of the Paralympics opening ceremony. </span><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;">A statue of Sir Ludwig Guttmann has been installed in
front of the Spinal Injuries Centre</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Three members of staff received national awards during the year.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">In the first quarter of 2013/2014 even the HSMR has
dropped below 100, it is now 97! <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">As the Chief Executive, Anne Eden, said “It was the best
of times and the worst of time”.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The hospital had over a million contacts with patients
and 5770 babies were born. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">There have been service development and a £5M capital investment
in A&E is being undertaken.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">As part of their response to the Keogh report they have
started an “Every Patient Counts” action
plan designed to improve services.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">But the future is challenging as the health and social
care economy has been under stress for many years and will be even tougher in
future years. The CCG which is a major contributor to the income of the
hospital is looking at a shortfall in its budget next year. There are difficult
decision to be made in this year’s commissioning round which starts now.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The cost of the staff in the hospital accounts for 59% of
the total expenditure of the trust.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">There was a presentation by the emergency surgery team on
how they have been redesigning the way in which they manage things. They admit 3800 patients a year of whom 500
are over 80 years of age. They see three
times that number altogether.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">I found it a bit confusing when they talked about
emergency surgery that does not need to be done that day and the fact that
their patient could be reasonably well.
Some patients can even stay at home.
This is obviously a version of ‘emergency’ that is new to me. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">It was amusing to hear surgeons talking about holistic
care!<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">The CE presented some internal awards to staff who had
“Gone the extra mile” for patients.
These were people nominated by their colleagues and patients and from
the hundreds of nominations a small number were selected. They were both clinical and non-clinical
staff and it was a nice way to end the formal part of the event. Congratulations to those who received an
award.<o:p></o:p></span></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNe2rey2gwDB68KiEy6tcs1-uPPupR5sRj20riU7bqafug4jN7K41Z9Fh3kB3wXY46jN7rR7FZ10zoIr8lvKxiz9oLFDajTpmzEwwUXL5EwWO9INEfse-qbjSFDP3V_SZsfNnxpTH_npYE/s1600/P1090664.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="309" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNe2rey2gwDB68KiEy6tcs1-uPPupR5sRj20riU7bqafug4jN7K41Z9Fh3kB3wXY46jN7rR7FZ10zoIr8lvKxiz9oLFDajTpmzEwwUXL5EwWO9INEfse-qbjSFDP3V_SZsfNnxpTH_npYE/s320/P1090664.JPG" width="320" /></a></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">There was a final event when the statue of ‘Poppa’ Ludwig
Guttmann was formally donated to Stoke Mandeville
Hospital by the charity that had raised the money for it and other projects. <a href="http://www.poppaguttmanncelebration.org/">http://www.poppaguttmanncelebration.org/</a><o:p></o:p></span></div>
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<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">At the end of the meeting there was time reserved for the
audience to ask questions. I will
discuss what happened then in the next blog. <o:p></o:p></span></div>
A stone in the shoehttp://www.blogger.com/profile/10150824189023007846noreply@blogger.com0