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Tower Hamlets Primary Care Trust

Tower Hamlets Primary Care Trust. Improving quality in primary care through APMS. Background to St Pauls Way GP Surgery. History of poor clinical and poor quality care by previous GPs Contract (GMS) sanctions followed by existing providers retiring Taken into PCT management for 12 months 2006

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Tower Hamlets Primary Care Trust

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  1. Tower Hamlets Primary Care Trust Improving quality in primary care through APMS

  2. Background to St Pauls Way GP Surgery • History of poor clinical and poor quality care by previous GPs • Contract (GMS) sanctions followed by existing providers retiring • Taken into PCT management for 12 months 2006 • c.10,800 list • 57% local population Bangladeshi and very high health inequalities in the area.

  3. Options and rationale • GMS – services in borough generally average with few mechanism within GMS to lever big enough changes needed • PMS – not time limited and right of reversion to GMS • SPMS – not relevant in this situation • APMS – only option as can incorporate any performance measures that a contractor would be prepared to sign up to. Financial risk reduced with shorter contractual term. Only contract mechanism that allows financial penalties.

  4. Key Performance Indicators • Supply: Appts offered – 105 per 1,000 patients per week. Waiting times – minutes waiting time for each appointment Opening hours (8-8 weekdays and 9-5 Saturdays) Access targets as minimum, not optional Clinical staff availability specified by PCT Telephone responsiveness

  5. Key Performance Indicators • Demand DNAs – numbers set by PCT not to exceed… Registered list growth and management inc % who live outside boundary, list maintenance PBC activity – Emergency and OPD utilisation not to exceed… Patient Satisfaction to be at least….

  6. Key Performance Indicators • Quality • PPI activities specified as minimum • Wider public engagement with locality – schools, voluntary sector • Staff surveys, training, performance management • Annual report • QOF • Complaints • THPCT Balanced score card (inc. nationals stds e.g. cervical screening etc as minimum and not voluntary – all standards to be met and higher. • Clinical governance inc. SfBH

  7. Management of the contract • KPIs monthly, quarterly and annual • Provider expects the PCT to manage through KPIs • PCT is “hands off” • Any contract change requires formal variation

  8. Outcomes include • Relationship between PCT and provider is purely contractual so both parties clear on expectations • Provider increase in quality directly related to income • PCT time used to monitor contract not “support” so clear use of resources

  9. Comparison to GMS/PMS • All services (core, additional and enhanced) included with one contract as a minimum • KPIs very clear and will terminate contract if not achieved (less precise in GMS) • Risk reduction of poor quality by limited life of contract period (GMS in perpetuity) • Detail of contract means quality standards very clear (less precise in GMS)

  10. APMS and Health Inequalitiescontract components for THPCT • Includes GMS contractual must do’s: • Access • Quality • Range of enhanced services e.g. smoking, breast cancer • Upper end performance mandatory etc • Plus for example: • Establish expert patient initiatives • Work with local authority services • Pro active links with local schools and employment initiatives • Learning opportunities by extended use of computers in waiting areas

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