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Charles Dobson


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

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

  • 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
  • Next steps

What is quality?
A positive environment
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
  • Investment in community facilities

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
  • (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.

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

High quality care for all the quality
improvement model
Quality improvement
Service innovation
Quality indicators Local National
Local needs and priorities
National standards
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
  • later this year
  • Planning under way for pilot looking at possible
  • synergies between accreditation of stroke
  • and revalidation of individual physicians

What is accreditation for?
  • Quality assurance?
  • Quality improvement?
  • Or both?
  • Emphasis on assessment against national (minimum)
  • Summative assessment methods attainment of
    standards needs to be supported by robust
  • 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

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

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
  • Cost-effective way of achieving pathway redesign
    (eg intermediate step up/step down services
    between primary and secondary care)

Balancing risk and innovation
  • Accreditation of PwSI services gives assurance to
    PCTs (and patients) that services remain safe and
  • Vital to accredit individual skills and service
  • 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

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!