GERAINT WYNNE - JONES

2. GERAINT WYNNE - JONES • INDEPENDENT • NOT from LHB • NOT fromTRUST • NOT from OOH PROVIDER

3. DECLARATION OF INTEREST (PERSONAL NOT FINANCIAL)

8. WHEN ALL IS SAID AND DONE- A LOT MORE IS SAID THAN DONE • W.E.C.A.C. • D.E.C.S • DESIGNED FOR LIFE • MAKING THE CONNECTIONS • WANLESS • 1000 LIVES • FULFILLED LIVES,SUPPORTING COMMUNITIES • M.U.C. • TIME TO MAKE A DIFFERENCE

9. MODERNISING UNSCHEDULED CARE M. U. C. *************** The Medusa of Unscheduled Care

13. UNDERSTANDING OUR MEDUSA • WHAT IS UNSCHEDULED CARE? • HOW BIG IS THE PROBLEM? • WHO ARE THE “SNAKES”? • $ 6,000,000 ? HOW????? • WHAT CAN PRIMARY CARE OFFER?

14. WHAT IS U.C.? ANY UNPLANNED HEALTH OR SOCIAL CARE TO PATIENTS WHO NEED HELP TO CARE FOR THEMSELVES AT HOME WALES AUDIT OFFICE NOVEMBER 2008 ANY EPISODE OF CARE PROVIDED FOR THE PATIENT WHICH IS UNPLANNED AND MAY REQUIRE PROMPT ACTION IN RESPONSE TO AN ACUTE, MINOR OR MAJOR INJURY OR ILLNESS WAG 2008

15. HOW BIG?

16. UNDERSTANDING HOW THE PUBLIC CHOOSES TO USE UNSCHEDULED CARE SERVICES : AWARD :CHIRAL:June 2008

17. HOW BIG? WALES 2007- PATIENT CONTACTS A+E 740,326 NHSD 360,000 GP 2,650,000(ESTIMATED)

18. UNSCHEDULED CARE

19. FIRST CONTACTS GPs 63.5% NHSD 6.0% A+E 5.5% 999 3.3% MIU 1.1% UNSCHEDULED CARE –TRUE PERSPECTIVE?

21. MEDICAL STAFFING LEVELS 1997 TO 2007

22. HEALTH BUDGET SCOTLAND 2006-07 (£BILLION)

23. FAMILY HEALTH CARE 2006-07 (£BILLION)

24. HOW BIG IN 2031 ? POPULATION WILL INCREASE BY 11% PENSIONERS WILL INCREASE BY 31%

26. WHO ARE THE “SNAKES”? • GPs • W.A.G. • TRUSTS • LHBs • WAST • NHSD • SOCIAL SERVICES • MENTAL HEALTH • PHARMACISTS • I.T. • PRESS • PATIENTS • SOLICITORS

27. W.A.G. • CONSTANTLY SEEM TO WANT TO BE SEEN DOING SOMETHING ABOUT THE POLITICAL HOT POTATO OF HEALTH • THEY ENCOURAGE THE “MEETINGS” CULTURE • THEY CREATE SOME OF THE U.C. PRESSURES • THEY NEED TO GIVE CLEAR GUIDANCE TO PATIENTS • THEY ARE OBSESSED WITH DATA AND EXERT NEEDLESS PRESSURE BY TARGETS

28. “Politicians use statistics like a drunk uses a lampost – for support not illumination” ANDREW LONG

29. Do A+E clinical staff feel able to deliver acceptable standards of service within the 4 hour target?Paul Stevens M.A. Business Management Thesis 2008 • 95% front line staff felt that the imposition of the 4 hour target had negatively impacted on the clinical care of patients. • Pressure to meet time limit conflicted with professional care standards. • Quantitative care was secondary to qualitative care.

30. TRUSTS • HAVING A HARD TIME LATELY • HAVE MADE SOME VERY POSITIVE CHANGES • TENDENCY TO BE SELF – CENTERED • SOMETIMES ONLY PAY LIP-SERVICE TO THE CONCEPT OF CO-OPERATING WITH THE WIDER HEALTH COMMUNITY?

31. LHBs • LOCALLY “DISTANT” • IDENTITY CRISIS – REPRESENTING PRIMARY CARE - BUT ARE THEY? • PROPOSED CHANGES 2009 MAY IMPROVE LINKS WITH GRASS ROOTS • L.E.S. AND D.E.S. IMPACT ON PRIMARY CARE CAPACITY TO PROVIDE U.C.?

32. WAST • THE GLAMOUR BOYS (AND GIRLS) OF U.C. ! • HARD WORKING • MADE BIG CHANGES TO WORKING PRACTICES • BEST USERS OF THE MEDIA TO ACHIEVE THEIR AIMS (SLIGHT PRIMA DONA COMPLEX?) • THE IMPACT OF EXTENDED ROLE PARAMEDICS ON U.C.?

34. NHSD • ON GOING IMPROVEMENT SINCE LINK WITH WAST • WHY NOT MORE POPULAR WITH THE PUBLIC? • WHAT SCOPE FOR INCREASING CALLS?

35. COMPUTER SAYS……. • CALL YOUR GP • DIAL 999 • GO TO A+E

36. SOCIAL SERVICES • A VAST ARMY OF “SNAKELETS” WORKING BEHIND THE SCENES • OFTEN VILLIFIED BECAUSE NOT AVAILABLE 24/7 AND NOT SEEN • A VITAL ROLE IN THE KEEPING IN, AND RETURNING OF PATIENTS TO, THEIR COMMUNITY • BACK INTO THE VIVARIUM OF HEALTHCARE?

37. MENTAL HEALTH TEAM • A SMALLER GROUP OF PATIENTS BUT MORE TIME-CONSUMING OF STAFF • APPEAR TO HAVE DIFFERENT TIME-SCALES TO THE REST

38. PHARMACISTS • MINOR AILMENT ADVICE MAY RELEASE CAPACITY IN PRIMARY CARE BUT NO DATA TO SUPPORT THIS SERVICE? • WHAT ABOUT MINOR AILMENT NURSES IN PHARMACIES WITH OPEN ACCEESS TO LOCAL GP SURGERIES?

39. I.T. • NOT FOR DATA COLLECTION BUT TO SECURELY SHARE PATIENT INFORMATION BETWEEN CLINICIANS • I.H.R.(INDIVIDUAL HEALTH RECORDS)

40. THE MEDIA • A LOT TO ANSWER FOR !! • USEFUL COMMUNICATION TOOL • VIPEROUS – QUICK TO BITE,VENOMOUS AND NOT CHOOSEY ABOUT PREY ! • COZY WITH WAST AT PRESENT - BUT BEWARE – KNOWN TO TURN ON THEIR YOUNG !

41. PATIENTS • CHANGING DEMOGRAPHICS HAS MADE THEM VULNERABLE • NO LONGER SURE WHERE TO GO FOR HELP • WHY DO SO FEW ACCESS NHSD? • NEED GUIDANCE FROM W.A.G. AND PROFESSIONALS BEFORE THE EVENT • SIGNPOSTING

43. DR. FINDLAY’S CASEBOOK

45. GPs • LOTS OF GOOD GPs - SOME BAD GPs • ADEPT AT JUMPING THROUGH W.A.G. HOOPS • ACCESS STILL A PROBLEM IN REALITY • LACK OF CAPACITY AN ISSUE – SMALL INCREASE IN GPs IN WALES • LACK OF MINOR ILLNESS NURSE PRACTITIONERS • TARGETS AND C.D.M. LIMIT U.C. CAPACITY

46. GPs OUR ROLE HAS BEEN CHANGED BY W.A.G. WE ARE NO LONGER DOCTORS OF ILLNESS - WE HAVE BECOME MANAGERS OF WELLNESS

47. OTHERS • SOLICITORS- THE AMERICANISATION OF MEDICAL LITIGATION IS IMPACTING ON U.C. MANAGEMENT. GPs ADEPT AT MANAGING RISK BUT BECOMING MORE DEFENSIVE MEDICO-LEGALLY- ? REASON FOR GP ADMISSIONS INCREASING- JUST LIKE CONSULTANTS IN A+E/AMU ADMITTING TO DECIDE NOT DECIDE TO ADMIT- SO PUTTING FURTHER PRESSURE ON THE SYSTEM

48. $6,000,000 QUESTIONHOW?

50. INPUT THROUGHPUT OUTPUT PRE –HOSPITAL INPATIENT DISCHARGE INDUSTRIAL MODEL OF CARE