Dr Foster Intelligence | Case studies

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Success stories

Dr Foster Intelligence's tool is key.

Andrew Fenton Head of Information and Performance

Bringing care to the patients

Most of Oxfordshire's 82 practices have historically not had direct access to data relating to activity in secondary care, whether for planned or emergency admissions. With the practices now split into six consortia in order to better manage care across the county, they have been forced to address that lack of data.

West Oxfordshire GP, Dr Stephen Smith is one of the GPs at the vanguard of this embracement of practice-based commissioning. As chair of a locality group of nine practices, Dr Smith leads the commissioning of care for 79,000 patients which involves a budget of £30 million.

Solution

Since January 2007, all practices have had access to the Dr Foster Intelligence practice based commissioning tool, Practice and Provider Monitor (PPM).

"This set-up allows us to deliver real local improvements for patients," said Smith.

Oxfordshire PCT's head of information and performance, Andrew Fenton, shares Smith's enthusiasm for service improvements and redesign.

Fenton says: "It's a steadily developing agenda. Practices are getting more engaged in understanding the importance of good-quality data and actually making use of it to inform their local plans. Dr Foster Intelligence's tool is key to that. We're providing support and training through our service managers in each cluster, not just on how to understand the data, but also on the process of PBC, such as how to support ideas around service redesign and improvement and areas of demand management, particularly in development of local services."

Smith is an advocate for the leading role of the clinician in commissioning local services.

He says: "Primarily, our interest as clinicians is about improving patient services. We also recognise that we need to make the best use of NHS resources. To do that, our consortia have highlighted 15 areas where we can do both: bring services into the community and make them more responsive, and save money."

Outcome

Fenton has already detected signs of change and highlights improvements made to the diabetes care pathway.

"If you look at the data on the Dr Foster Intelligence tool, it's very visually evident, from the colour coding it provides that compared to the national average, the rate of activity in the specialist clinics at the hospital are high. So there's clearly a lot of capacity for much more effective management of diabetes, where appropriate, within primary care.

"With any data analysis, it prompts questions that need to be investigated, and sometimes the answer may be that it could be poor-quality data, but equally it could be the case of the demographics, levels of deprivation, or down to patterns of service provision or referral.

"For example, the fact that we have a very high quality diabetes centre on our doorstep (at the Oxford Radcliffe Hospitals Trust) affects the pattern of diabetes care locally. Patient expectation could also be a factor, as they have gotten used to regularly seeing the local hospital-based expert."

Fenton's team have also used the PPM tool's data in a recent discussion with a practice manager about modelling the level of demand the practice might face if it were to run an outpatient clinic in primary care dermatology.

"We looked at the numbers of patients they might expect to see which helps practices build a business case. From the business case they can make a clinical judgment, with input from secondary care, as to what follow-up activity could reasonably be handled within primary care and what proportion would still be seen by secondary care.

"Data is one part of the judgment and decision-making process. A lot of it relates to, or depends upon, good clinical judgment and other evidence as well."

Tool

Practice and Provider Monitor