Primary Care Trusts: modernising the NHS?

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Primary Care Trustsmodernising the NHS?

• Diane Jones
• Research Fellow

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Overview

• PCGs and PCTs in the new NHS
• National Tracker Survey of PCGs PCTs
• Research findings
• Conclusions

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Primary Care Groups and Trusts in the New NHS

• One of the most radical reforms since 1948
• Modernisation agenda reliant on PCTs
• IfH reliant on PCTs

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Health Service Reforms

• Core Functions of PCG/Ts
• Improve health of the local population
• Commission hospital community based health
  services
• Develop primary community health services

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Funding
Strategic Health Authorities approx. 1.5 million
population
Primary Care Trusts approx. 200,000
population Primary Care Community
Services Health
Services
Hospitals
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Information Flows
Strategic Health Authorities approx. 1.5 million
population
Primary Care Trusts approx. 200,000
population Primary Care Community
Services Health
Services
Hospitals
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The National Tracker Survey of PCGs and PCTs in
England

• Longitudinal survey - 72 PCGs
• Oct-Dec 1999, Oct-Dec 2000 Jan-Mar 2002
• Describe/evaluate achievements and obstacles
• Interviews - CEO, Chair, HA Lead
• Postal questionnaires

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Modernising Primary Care

• Improving access
• Extending the range of services
• Increasing the workforce capacity
• Integrating primary and community services
• Improving quality
• Information and IT systems

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Initiatives to improve access
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Extending the range of services through sharing
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Enhancing workforce capacity
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The Vision
Mental Health Services Electronic Patient Record
Hospital based Electronic Patient Record
Primary Care Electronic Patient Record
Community Services Electronic Patient Record
Social Care Records
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Modernising Information Systems

• Are information systems meeting the needs of
  PCG/Ts?
• Will the targets set out in Information for
  Health and NHS Plan be met?
• Development of IMT in general practice

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GP systems - current position

• High level of computerisation
• Accredited GP systems
• Erratic development
• Data quality questionable

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Research Questions

• What are the information needs of PCGs and PCTs?
• Do current information systems meet needs?
• How can information systems be improved?

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IMT in PCGs and PCTs

• Postal questionnaire - IMT Lead
• Response rates
• Year 1 53 (n38)
• Year 2 72 (n51)
• Case Studies
• Selected Findings

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of PCG/Ts where information systems meet needs
well or very well
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PCG/T Information Systems

• Poor/ very poor data from
• Community Health systems (84)
• GP systems (63)
• Hospital based systems(63)
• Most had e-links to NHS Net Internet
• Few with e-links to practices hospitals

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of PCG/Ts reporting more than half of practices
using selected links
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of PCG/Ts reporting more than half of practices
using information management tools
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Education and Training

• 24 had an E T policy for IMT
• 46 aimed to by April 01
• 23 of PCG/Ts signed up to PRIMIS
• 26 had plans to sign up to PRIMIS

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of PCG/Ts confident of meeting national targets
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Obstacles to progress on IMT targets

• Inadequate levels of IMT staff (71)
• Poor budget information
• LIS does not reflect PCG/T needs
• Funding diverted

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Obstacles to Progress - general (PCG/T Chief
Officers)
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Conclusions

• PCG/Ts are
• taking action to improve access to primary care
• extending the range of services by sharing
  resources between practices
• working to increase capacity through extended
  professional roles

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Conclusions

• Development of primary and community services -
  high priority for PCG/Ts
• PCG/Ts are making an important contribution to
  NHS modernisation
• Inadequate management capacity and resources are
  seen as major obstacles to further progress
• Continuing tension between central control and
  local autonomy

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Conclusions

• Information to support core functions is
  inadequate
• Ability to meet national targets is doubtful
• Practice systems - key source of data
• GP systems advanced but data quality inadequate
• Use of information tools in general practice very
  low
• Essential to improve data quality
• Substantial investment required

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The Third Tracker Survey

• Third survey underway
• Findings published in Autumn 2002
• www.npcrdc.man.ac.uk