Commissioning
The new GMS contract recognises that if the primary care sector is to be expanded and practices are to be allowed to manage their workload and earnings to suit their aspirations, a clear strategy to use clinicians’ time effectively whilst improving availability of services for patients is essential. This strategy will identify those situations in which patients could be enabled to manage their own conditions, use services effectively, or where the services could be offered by other health professionals, especially where these services could be accessed more easily and more cost effectively than through traditional general practice.
(6.46 - Investing in General Practice - The New General Medical Services Contract 2004)
The Challenge
- A proactive approach to managing demand for musculoskeletal services
- More efficient and effective services across the PCT
The Role of the WAT
- Access to detailed and accurate data identifying the extent of the workload by individual clinicians
| Task |
Information Source |
Results & Potential Solutions |
| Identify areas of high workload to the practice |
Workload Analysis Tool |
Musculo-skeletal |
| Examine top codes making up this chapter |
Workload Analysis Tool |
Back pain, limb pain, and joint pain |
| Identify which clinicians are currently dealing with this workload |
Workload Analysis Tool |
GPs or Nurse practitioner or one particular GP |
| Does it result in a lot of referrals or hospital admissions? |
Other sources and Workload Analysis Tool |
Chapter 8H codes or data supplied by PCT from secondary care |
| Is there capacity within the current team to provide an alternative service? |
Workload Analysis Tool |
Train a GPwSI, increase physio input, employ practice based physio, pain management clinic |
| Are there alternative services already available? |
Other agencies |
Exercise programmes on prescription, Expert patient group |
| Effect of using current team member in a new care pathway on the workload of the rest of the team? |
Workload Analysis Tool |
Will other team members need to work extra hours to cover or can work be shifted to areas of over capacity |
| What are the demographics of the patients concerned? |
Workload Analysis Tool |
Mobility problems in the elderly, transport issues, younger people who may need a service out of working hours |
Solution
- Planning for new services based on patient demographics
- Full musculoskeletal pathway review
- GP partner producing pathway aide memoir for desktops showing all possible treatment options;
- Self care - Expert Patient Programme
- Physio Direct Service
- Pain Management Clinics
- Fit for Life exercise on prescription programme
- Musculoskeletal workload reduced by 14%
- Enabled practice to contribute practice level workload data to PBC Service Redesign planning
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