Dr Foster Intelligence

Commissioning

Problem: High cost of outpatient appointments
Solution: The practice used Dr Foster Intelligence's Practice Based Commissioning tool too look at who they were referring to hospital and why. They identified 13 areas of care that could be treated more cost-effectively in primary care than in secondary care. This created a more beneficial pathway for patients, especially those who were elderly or suffering from long-term chronic diseases.
Outcome: Within a short time, the practice identified many areas in which it can set up specialist clinics to help drive down costs, including dermatology, ultrasound and lipid-lowering. It is now hoping to implement a ten-year plan based on the information it is currently using.
Tool: Practice and Provider Monitor

Problem: Practices wanted to involve patients more in the plans for new care pathways and also wanted to emphasise improvements to care, rather than simply making financial savings.
Solution: A patient's forum group was created where all ideas are discussed before being pursued by the consortium. Also, the consortium is beginning to focus on managing demand, now that the initial service pathways have been redesigned.
Outcome: The waiting time for ultrasounds has dropped by 14 weeks to four, and plans are being piloted for local dermatology and ophthalmology care.
Tool: Practice and Provider Monitor

Problem: The Trust wanted to fully engage all its GPs and practices in the commissioning process and develop an information culture.
Solution: GPs are now monitoring expenditure and activity, and the Trust has appointed a dedicated Commissioning director.
Outcome: A substantial cost savings has already been made, and many more GPs and practice managers are involved in monitoring the care they provide and are participating more fully in the commissioning cycle.
Tool: Practice and Provider Monitor

Problem: A&E admissions had risen by 25 per cent in the last two years, and the Trust wanted to find a way to encourage behaviour change in the local population and save money at the same time as it was providing better care.
Solution: A primary care unit is being designed for implementation in A&E. The unit would be staffed by primary care professionals and would screen everyone coming into A&E in order to decide who should be better cared for in the community.
Outcome: Practices are working together to look at other areas of care that could more effectively be treated by primary care staff and are planning further pilots.
Tool: Practice and Provider Monitor

Problem: GPs were historically in the dark when it came to monitoring the activity of their patients in secondary care.
Solution: All the general practices in the area joined together to form locality groups and began using Dr Foster Intelligence's Practice and Provider Monitor tool to better manage data and provide more effective patient care.
Outcome: The Trust is examining its diabetes care pathways to find a way to maximise the use of the local diabetes specialty centre and is working with the local practices to better manage care in 15 different areas.
Tool: Practice and Provider Monitor

Problem: The Trust wanted a way of better understanding the reasons behind certain aspects of its activity - specifically the high number of acute admissions for COPD.
Solution: A district nurse has been employed as a practice nurse to work from patients' homes and provide pre-assessments that let practices better manage care, for both long-term conditions and other problems.
Outcome: Both the Trust and practices have a better understanding of the local population health needs and can better track and manage care for patients, saving time and money for everyone involved.
Tool: High-impact User Monitor and Practice and Provider Monitor

Problem: The 41 practices that make up Shropshire's five localities wanted more detailed information sooner than they were receiving it at the time. The PCT was very helpful in its release and examination of data, but the localities and practices did not have the time they needed to go back and forth to the PCT to check and re-check specific queries against top-level reports.
Solution: The locality chairs considered their information solution options and decided on three of Dr Foster Intelligence's web-based analytical tools. Supported by the PCT, they are now in the process of analysing trends and implementing improvements to patient pathways.
Tool: Practice and Provider Monitor and Real Time Monitoring

Problem: The consortium was spending too much time asking local trusts to re-examine data that the GPs wanted to interrogate.
Solution: The consortium has saved time and money by drilling down into the data available in Dr Foster Intelligence's tools and is now able to much more rapidly push forward their commissioning and service redesign plans.
Outcome: Waiting times and re-referral rates have dropped, and the group is piloting care programmes for the community such as dermatology and deep vein thrombosis.
Tool: Practice and Provider Monitor

Problem: There were areas of care that were difficult for patients to take advantage of and that were costing GPs a lot of money.
Solution: Care pathways were examined, and the use of data was improved.
Outcome: Areas of care that could be much better provided in primary care are being piloted and practices are working together to improve data across the entire local health economy.
Tool: Practice and Provider Monitor

Problem: Sporadic engagement with practice based commissioning meant that resources and improvements were not being maximised.
Solution: A PCT-wide consortium has been formed to allow GPs to get the most out of their shared expertise, local knowledge and contacts.
Outcome: The consortium has set the GPs the task of identifying their top 10 most expensive patients and is planning on directly addressing the relevant problems in order to save time, money and resources by better designing care pathways.
Tool: Practice and Provider Monitor