Dr Foster Intelligence | Case studies

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Success stories

Now I can have meaningful discussions with practices and refer directly to numbers because we all have the same data.

Mike O'Bryan PBC Management Lead

Redesigning services to improve care

Identifying potential efficiencies is the first step to take in the process of improving services and saving money. Last November, a former patient representative for the PCT, Mike O'Bryan, was asked by his GP to lead the area's PBC efforts.

O'Bryan is now the management lead for one of the PBC clusters within Wandsworth PCT.

As a cardiac patient himself he has first-hand knowledge of healthcare in the NHS.

"One of the simplest, but most effective changes we could make involves the distribution and management of anti-coagulant drugs. Having been on Warfarin for a while, I used to have to go up to the hospital and was always amazed by how many people relied on transport provided by the hospital - they were disabled or infirm and couldn't cope with public transport. Someone pays for that [transport], but it's impossible to find out who does. If we could provide this service in primary care, there are possibilities of huge savings because patients can go to their GP, which is close to home."

Solution

With GPs now using the Practice and Provider Monitor tool, along with the PCT, O'Bryan is now in position to discuss patient activity, efficiencies and costs in detail, which is currently being piloted.

"Recently, I carried out a review of one practice's referral activity in seven key areas. This only took me around an hour to do using the Dr Foster Intelligence tool.

"What I found was an overall decline in referrals, with a nine per cent drop in one particular area. It was very encouraging. Follow-up appointments were also down.

"Now I can have meaningful discussions with practices, and refer directly to numbers, because we all have the same data.

"I can now ask: 'Do you understand this is going on?' and expect to receive reasons to explain why," said O'Bryan.

Outcome

The Trust is now working with practices to analyse different areas of care that could potentially be done more efficiently by GPs and other primary care providers.

Current pilots include having patients receive anti-coagulant drugs from their GP, rather than the hospital, and having a community ophthalmologist.

"The problem we have now is that we don't know when a patient is referred to secondary care by an optician," said O'Bryan. "There will obviously be a cost impact to the individual practice (if their patient is seen by an NHS ophthalmologist) but practices usually don't even know when a patient has been referred.

"It is good that the patient is being checked out - after all, this is about patient care, not about saving money, as I keep telling practices - but we must have an understanding of how resources are being used and find ways to use them better."

Two other service redesigns that have recently been approved for the locality groups are diabetes and electro-cardiograms (ECG).

"In terms of ECG, we can do it an awful lot cheaper in primary care - overheads are lower and it's closer to home for patients. With diabetes, it's a joint initiative with St George's (the local secondary care provider). We're putting together a community clinic where people can be seen by a consultant specialist, their GP and a practice nurse, on their own turf. This has got to be better for the patient because they don't have to travel," he continued.

Tool

Practice and Provider Monitor and Real Time Monitoring