A Primary Care Trust Perspective NHS North Lancashire
- Slides: 21
A Primary Care Trust Perspective NHS North Lancashire
Dr Jim Gardner Medical Director & PEC Chair NHS North Lancashire Jim. gardner@northlancs. nhs. uk
PCT Perspective • Corporate Objectives • Commission health care • Improve health outcomes • Reduce health inequalities • Achieve financial balance • ‘Patient Safety First’ • Whole-systems thinking • Not experts in VTE
VTE Improvement Cycle Understand Raise awareness Measure Set standards
Sources of data • Primary Care – PRIMIS – Qo. F • Secondary Care – Regional Data Warehouse (SUS) – CHKS – Hospitals’ own – pathology/haematology
Primary Care Prevalence from PRIMIS searches Total number of patients diagnosed with either DVT or PE as a % of a total GP population of 298, 371 (5 practices data was not included due to discrepancies in the data collection)
Primary Care Patients on Warfarin from PRIMIS search Total number of patients prescribed Warfarin (in last 3/12) from the total GP population of 298, 371 (5 practices data was not included due to discrepancies in the data collection)
Annual Hospital Incidence from SUS data. Data from Cumbria & Lancashire Commissioning Intelligence Support (Ca. LCIS) North Lancashire Residents (population 340, 000).
Benchmarked Analysis of Venous Thromboembolism 2006 -2008 data
Venous Thromboembolism – primary or secondary position
Venous Thromboembolism – Length of Stay by type 2008 only NHS North Lancashire - Population 340, 000.
Venous Thromboembolism – mortality rates 2008 only NHS North Lancashire – Population 340, 000
VTE Improvement Cycle Understand Measure Raise awareness Set standards
Commissioning for Quality • What is quality? – Safety, efficacy, personalisation, outcome • ‘Advancing Quality’ – carrots v sticks • Risk Assessment for all hospital admissions embedded in contracts • Financial support to providers • PCT Project Manger for VTE to monitor and support – Audits / Root Cause Analyses/ Trajectories
Refining DVT diagnosis in primary care • • >140, 000 referrals for ? DVT/year in UK 80 – 90% do NOT have DVT Need to refine tests in primary care Clinical Decision Process including nearpatient-testing • ‘Safely Ruling out Deep Venous Thrombosis in Primary Care’. Buller et al. Ann intern Med. 2009; 150: 229 -235 • One PBC consortium implementing.
VTE Mind Map from PCT Perspective
Project Plan • • Understand the data and the issues Raise awareness Set standards in contracts Support improvement initiatives Measure outcomes Link VTE to other initiatives Manage the project through a Lead Share learning
Questions • In our PCT area, our two acute hospital trusts have different heparin regimes at discharge. This causes confusion for our community staff. • In the interests of safety, should we (as a PCT) seek to standardise heparin protocols across our health economy? • Should we, as an exemplar community, look to standardise heparin protocols across England?
- Lancashire primary care trust
- Primary secondary tertiary health care definition
- Cumbria and north east ics
- Trafford primary care trust
- Sutton & merton primary care trust
- South birmingham primary care trust
- West essex primary care trust
- Greenwich primary care trust
- Maghull pct
- Myskillsfuture primary
- Qah
- Tasmin v barts health nhs trust
- Uhcw floor plan
- Uhl management structure
- Portsmouth hospitals nhs trust jobs
- Airedale nhs trust v bland
- Western sussex hospitals nhs foundation trust board
- North east nhs
- North east hampshire and farnham ccg
- Charitable work
- Nhs "volunteer responders"
- Lancashire county council planning