1 NORTH BLABY DEMAND MANAGEMENT SUMMARY November 2018
1 NORTH BLABY DEMAND MANAGEMENT SUMMARY November 2018
2 Improvements to Referral? The available national evidence on the current quality of referral suggests that: • not all referrals are necessary in clinical terms, and a substantial proportion is discretionary and avoidable • there are patients who need a referral but may fail to receive one • a large number of patients currently referred to secondary care could be seen alternative settings • a considerable number of referral letters lack the necessary information • there is frequently no shared understanding of the purpose of the referral among the GP, the patient and the consultant • the appropriate investigations have not always taken place prior to referral. “Referral management: lessons for success - The King’s Fund 2010”
3 Demand Management • There is significant variation in referral behaviour between GPs • Even allowing for similar demographics and disease prevalence • There is variation in the variation eg between specialities • You do not know what you do not know
4 ‘Care Optimisation’ • Referral Demand Management is not judgemental but about: • Quality improvement • Peer Review • Education • Using the best evidence (clinical and methodology) • Quick and slick processes • Integrated real time IT decision support probably the future
5 Grouping potential interventions HIGHER Referral peer review and Feedback Structured referral systems Patient Decision Aids Value Based Commissioning GP Education EASIER Clinical Referral Guidelines Undifferentiated restrictions on access to low value care Financial Incentives IMPACT LOWER Clinical Assessment and Triage Referral Management Centres IMPLEMENTATION Shared Decision Making
6 CCG Demand Management: Support and Investment Plan • Improve Care • Maximise best use of resources *************************** • Practice to achieve Locality average • Locality to achieve CCG average • Current referral rate increasing by 2% / year • To reduce referral rate to 1% in this year
7 Federation Support for Demand Management • Develop a reporting template for the 6 localities that will be produced on a quarterly basis and inform continued open debate • Standard data sets • Commentary on performance • Themes / ‘best practice’ • Priority areas for focus & development • Service development opportunities • Learning needs
8 North Blaby Summary • High A+E Attendance • Higher than average emergency admission rate • Referral rate better than CCG average • Lowest overall discharge after 1 st appt rate • Year on year improvement in overall referrals 16/17 17/18 (8. 3/1000)
9 North Blaby Locality Highlights (Benchmarked numbers per 1, 000 patients per year) CCG Average Lowest Highest North Blaby A+E attendances 192 (202) 139. 2 231. 5 229. 2 (237. 9) Total Emergency Admissions 96 (89. 9) 73. 8 115. 9 98. 5 (89. 8) GP / Bed Bureau Admissions 23 (19. 7) 14. 3 29. 9 23. 6 (20. 3) Total Referral 181 (184. 9) 162. 5 220. 4 171. 7 (165. 8) Discharged after 1 st OPA 66 (68. 9) 63. 7 71 63. 7 (62. 5) Advice and Guidance 7 (11) 5. 5 11. 4 5. 5 (12. 9)
10 North Blaby Referral Summary (Only GP instigated referrals) Total 17/18 referrals Benchmark referral rate per year/1000 Predicted 2% Increase (referrals /yr) Aim 1% Max Increase 18/19 (referrals/yr) Enderby 953 151. 5 10 20 Forest House 3, 317 229. 7 (>1 SD) 66 33 Glenfield 2, 251 161 46 23 Kingsway 1, 502 145. 8 30 15 Limes 2, 245 155. 8 46 23 North Blaby 171. 7 North Blaby (1 SD) 32. 6 ELR CCG 181 Significant decrease in referral 16/17 - 17/18 of 8. 3/1000
11 Areas Locality > CCG • Dermatology • ENT • Gynaecology • General medicine Areas Locality < CCG With Inter-practice Variation • Trauma and Orthopaedics • Cardiology • Urology
12 Locality Higher Referral Specialities (Only GP instigated referrals - benchmarked rates per 1, 000 patients) Gynaecology General Medicine 14. 4 9. 7 Dermatology ENT N. Blaby 16. 4 12. 3 Enderby 13. 7 9. 9 14. 5 5. 9 Forest Hs 23. 4 17. 1 17 14. 8 Glenfield 19. 1 11. 8 13. 7 8. 9 Kingsway 8. 9 13. 8 7. 9 Limes 14. 1 11. 4 13. 1 8. 3 ELR CCG 14 Highest Locality 16. 4 13. 7 14. 4 12. 9 Lowest Locality 12 10. 3 10. 8 6. 8 (17. 3) (15. 4) 12 (13. 7) (13) 13 (12. 3) (12. 4) 8 (9. 7) (9. 2)
13 Specialities with Intra-locality variation (Only GP instigated referrals - benchmarked rates per 1000 patients) Orthopaedics Disch 1 st Appt Cardiology Disch 1 st Appt Urology Disch 1 st Appt N. Blaby 17. 4 3. 6 8. 2 (9. 1) 2. 1 Enderby 16. 7 3. 8 2. 5 1. 4 7. 2 1. 4 Forest Hs 25. 9 5 11. 6 5. 5 12. 2 4. 2 Glenfield 15. 2 2. 9 8. 7 3. 4 6. 3 1. 1 Kingsway 14. 2 2. 7 7. 7 3 6. 1 1. 5 Limes 14. 7 3 6. 5 2. 5 8. 4 1. 8 ELR CCG 20 4 9 Highest Locality 25. 8 14. 2 8. 3 10. 8 2. 5 Lowest Locality 16. 9 3. 6 7 2. 7 7. 9 1. 8 (15. 3) (19. 2) (7) (9. 3) (9. 2) 2
14 North Blaby Next Steps • For the month of October, peer review and collect detail of all • • referrals to: Dermatology ENT Gynaecology General Medicine • Forest house to also consider possible reasons for local variance in Orthopaedics and Urology referrals • Glenfield and Forest House to also consider variations in referrals to Cardiology
15 North Blaby Locality – Month’s Referral Review (Only GP instigated referrals) Dermatology ENT Gynaecology General Medicine 14 10 12 8 29 25 15 8. 9 Kingsway (10304) 2 2 2 7. 9 Limes 13 10 9 8. 3 Enderby (6289) Forest Hs (14444) Glenfield (13983) (14408)
16 Key Themes • Overall referrals decreasing – possible 3. 4% v CCG rise of 2. 1% • A+E attendances increasing -------------------------------------- • Dermatology, ENT referrals rising • Gynae referral rate falling and General Medicine stable • Orthopaedics and Cardiology referrals decreased • Urology referrals increased slightly -------------------------------------- • ENT – Tinnitus and hearing loss, Tonsillectomy, Nasal / Sinus congestion • Gynae – Period issues / PCB and IMB • Dermatology – ‘lesions’ and 2 ww (14)
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18 Dermatology • Above average as locality • Kingsway: much lower referral rate within locality and with greatest year on year drop in referrals • Forest House and Glenfield: Higher referral rates with corresponding higher rates of discharge after first appointment. Glenfield showing year on year increase in referrals
19 ENT • Locality referral rate above CCG average • All practices showing improved year on year referral rate esp Kingsway • Kingsway and Enderby below locality and CCG average • Forest House although improved, has much higher referral rate with correspondingly higher 1 st appt discharge rates.
20 Gynaecology • Highest locality rate for gynaecology referrals with all practices above the CCG average. • Glenfield shows biggest year on year increase going from below average to above CCG average
21 General Medicine • Locality referral rate above CCG average • Kingsway only practice to show year on year fall in referrals with Enderby the only practice remaining significantly below the CCG average. • Forest House significantly higher referral rate with very much higher discharge after 1 st appointment rate.
22 Ophthalmolgy • Best Locality with referral rates for all practices well below CCG average
23 Orthopaedics • Locality referral rate below CCG average with largest year on year fall in referrals • Forest House significant outlier with higher referral rates and correspondingly highest rate of discharge after 1 st appoinment
24 Cardiology • Locality referral rate below CCG average • Forest House and Glenfield above the locality average • Enderby considerably below any other practice in the CCG for cardiology referrals
25 Urology • Locality referral rate below CCG average • Forest House referral rates much higher than both locality and CCG referral rates with correspondingly very much higher 1 st appt discharge rates • All other practices referral rates are below CCG average
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