Abstract
Population care needs: Patient wait times were amongst the highest in the UK, with increasing demand this was not sustainable, secondary care waiting lists were increasing and there was a need to reform non-urgent care pathways in NI.
Strategic view: In 2016 Integrated Care Partnerships (ICPs) within Northern Ireland appointed primary care clinical leads in a number of specialities to work specifically on a proposed programme for elective care reform (ECR). This was carried out in conjunction with GP federations (collection of GP practices) across Northern Ireland.
A review of patient care, led to the strategic direction outlined in Department of Health plans; Delivering Together and Transforming Patient Care.
Data on patients referred from Primary Care were reviewed as well as secondary care waiting lists.
This review showed:
•Variability of waiting times across the region
•High and Increasing wait times, for example gynaecology average 55 weeks wait for non-urgent care.
A number of Elective Procedures were outlined which could be delivered by GPs in Primary Care within the remit of the GP contract.
Design: Leads were appointed and new care pathways were developed enabling referrals to be made to General Practice Elective Care Services ie.
•MSK; Hand, Foot, Knee, Shoulder, Sports injury
•PCSS; Symptomatic cycst, Lipoma (under 5cm, not miduline / spinal), Symptomatic Actinic Keratoses etc
•Dermatology; ie. Adult eczema, Childhood eczema, Psoriasis, Acne, Non-specific rashes, Actinic Keratosis
•Vasectomy
•Gynaecology; HRT, Menorraghia <45, Long acting reversible contraception, Pessary replacement
A clinical governance structure was developed and the necessary staff job descriptions were written. Working collaboratively across a range of organisations was essential, ie. with the HSCB (now SPPG), HSC Trusts, Federations, NIMDTA.
Implementation: GPs were recruited and on completion of training were known as GPs with Enhanced Skills. Host practices were selected using a set criteria,across all federations and equipped with the resources required and an ordering process was established.
Training and information sharing sessions were delivered to promote the new service to referring GPs.
Challenges: When the service was launched it was a challenge to encourage referring GPs to use Primary Care Elective Services rather than Secondary Care. The service grew from referrals of an average of 115 per week in the first 5 months of operation in 18-19, to 320 per week in the same period in 22-23. Referrals were encouraged through education and information campaigns.
Outcomes:
Since its commencement in November 2018 over 63,000 patients have benefitted from Elective Care Services.
Patient numbers
Vasectomy 5720
MSK12278
Dermatology16807
Derm Surgery480
Gynaecology22952
Primary Care Surgical Service 4890
Total 63127
Waiting time for patients on average in 2022- 2023 was 27 weeks
Procedures are cost effective too, with the average vasectomy in secondary care costing £1397, versus £329 in Primary Care.
Patient Feedback: Patients love the service and feedback is excellent, 97% would recommend the service to family and friends. And 98% rated the service Good or Very Good. (2022-23 patient satisfaction survey).