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Charles Dobson

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8/22/09. Charles Dobson. NHS Medical Directorate, Department of Health ... Individual appraisal and revalidation. So where do PwSIs fit in? ... – PowerPoint PPT presentation

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Title: Charles Dobson


1
Quality care, closer to home
  • Charles Dobson
  • NHS Medical Directorate, Department of Health

2
Overview
  • The context
  • What is quality?
  • Care closer to home
  • Commissioning for quality
  • High quality care for all the improvement model
  • Developments in accreditation
  • Individual appraisal and revalidation
  • So where do PwSIs fit in?
  • Balancing risk and innovation PwSI
    accreditation
  • Next steps

3
EFFECTIVENESS
What is quality?
EFFECTIVE
A positive environment
4
Care closer to home
  • Our health, our care, our say (2006)
  • Why
  • Changes in expectations people want services to
    fit round them, not the other way round
  • Changes in technology more clinical activity
    can be delivered safely in the community
  • Increasing demands on the healthcare system,
    requiring strategy focussed on prevention and
    support in community (Wanless report)
  • Search for better value for money as growth rates
    slow down
  • How
  • Pivotal role of practice based commissioning/indic
    ative practice budgets to promote redesign of
    care pathways
  • Shift of resources from secondary to community
    care
  • Investment in community facilities

5
Commissioning for quality and innovation (1)
  • Health and Social Care Act 2008 replaced the
    previous duty of quality
  • (for all NHS organisations) with
  • registration requirements for providers,
    initially in secondary care
  • a duty on commissioners to seek continuous
    quality improvement, defined as follows
  • 1) Each Primary Care Trust must make
    arrangements to secure continuous improvement in
    the quality of health care provided by it and by
    other persons pursuant to arrangements made by
    it.
  • (2) In discharging its duty under subsection (1)
    a Primary Care Trust must have regard to the
    standards set out in statements under section 45
    of the Health and Social Care Act 2008.

6
Commissioning for quality and innovation (2)
  • World Class Commissioning sets out 11
    commissioning competencies including
  • engage with public and patients
  • collaborate with clinicians
  • prioritise investment
  • promote improvement and innovation
  • Use of financial incentives to drive quality
    improvement (CQuIN)
  • up to 0.5 of contract income held back and tied
    to achievement of specific quality improvements
  • choice of quality indicators for local decision

7
High quality care for all the quality
improvement model
Quality improvement
Service innovation
Quality indicators Local National
Local needs and priorities
National standards
8
Developments in accreditation
Existing schemes/schemes under development
  • Psychiatry
  • Radiology
  • General practice
  • Stroke services
  • Several schemes for individual subspecialisms
  • eg ECT
  • Pilots completed, national roll-out under way
  • Pilots being evaluated, decision on national
    roll-out
  • later this year
  • Planning under way for pilot looking at possible
  • synergies between accreditation of stroke
    services
  • and revalidation of individual physicians

9
What is accreditation for?
  • Quality assurance?
  • Quality improvement?
  • Or both?
  • Emphasis on assessment against national (minimum)
    standards
  • Summative assessment methods attainment of
    standards needs to be supported by robust
    evidence
  • Can act as proxy for registration of provider by
    Care Quality Commission
  • Standards will include developmental elements and
    scope for local variation
  • Emphasis on peer review to identify opportunities
    for quality improvement
  • Formative assessment methods

10
Individual appraisal and revalidation
  • Response to serious critique of previous
    arrangements in the Shipman Inquirys 5th report
  • Proposals in Trust, assurance and safety seek to
    combine elements of
  • quality assurance (summative appraisal)
  • quality improvement (formative appraisal)
  • Legislative underpinning now largely in place
    (Responsible Officers, Section 60 orders etc)
  • Standards and processes under development
    (Medical Royal Colleges) and pilots will start
    shortly

11
So where do PwSIs fit in?
  • Key element of moving care closer to home
  • Builds on natural strengths of general medical
    and pharmacy practice
  • Allows individual GPs and community pharmacists
    to develop specialised interests in a community
    setting
  • Cost-effective way of achieving pathway redesign
    (eg intermediate step up/step down services
    between primary and secondary care)

12
Balancing risk and innovation
  • Accreditation of PwSI services gives assurance to
    PCTs (and patients) that services remain safe and
    effective
  • Vital to accredit individual skills and service
    setting
  • Although primary aim is quality assurance,
    assessors and service providers can take
    opportunity to use the assessment process to
    identify areas for further quality improvement
  • Should be particularly helpful as component of
    individual revalidation

13
Next steps
  • Refresh of specialty specific guidance is almost
    complete available on PCC website or on CD
  • Deadline for reaccreditation of existing services
    is 31 March 2009
  • Once proposals from Medical Royal Colleges more
    fully formed, will look again at interaction
    between PwSI accreditation and revalidation to
    ensure no duplication
  • PCTs have to take account of guidance but
    duty of quality improvement is not optional!
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