Transcript Raising the quality of drug treatment: beyond the national

Raising the quality of drug treatment:
beyond the national standards
Clinician’s influences
Dr Chris Ford
GP and Clinical Director SMMGP
4th West Midlands Conference
What do we mean by quality
 An essential and distinguishing
attribute of something or someone
 Degree or grade of excellence or worth
 A characteristic property that defines
the apparent individual
Quality in health care
 The achievement of optimal physical and mental
health through:
 accessible, cost-effective care that is based on best
evidence
 is responsive to the needs and preferences of patients
and populations
 is respectful of patients' families, personal values and
beliefs
Quality and cost effectiveness of
care delivered in primary care
A systematic review of quality of care in general practice
concluded:
‘The published research in the field presents an incomplete
picture of the quality of clinical care’
But a substantial number of well-designed studies exist
comparing care by GPs to that of specialists, which show
‘no significant difference in quality of care and
health outcome for care delivered by GPs even
when substituted for secondary care
specialists.’
‘Primary care physicians are more likely than specialists
to provide continuity and comprehensive care
resulting in improved health outcomes’
Quality in drug treatment
 The achievement of optimal physical and mental
health through:
 accessible, cost-effective care that is based on best
evidence
 is responsive to the needs and preferences of patients
and populations
 is respectful of patients' families, personal values and
beliefs
 But quality of care vary with point of view and
role
 who may be patient, clinician, purchaser, or manager
 Descriptions of quality also depend on:
 clinical setting, patient expectations, and severity
illness
Quality depends on point of view
 Depend on who you are:
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Patient
Clinician
Purchaser
Manager
 Also depend on:
 clinical setting
 Patient expectations
 Severity illness
What have we had to help us?
 Frameworks
 QuADs, DANOS, MoC, TOPs
 Clinicians
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Clinical guidelines
Roles and responsibilities
Appraisals
Toolkit
RCGP Certificate
What have been the
constraints?
 Target driven
culture
 Risk aversive
Is the new agenda going to
help us?
Changing directions
 Less resources
 End of target
driven culture
 Back to local
priorities
 PCTs out PBC in
 Where to next?
Language: old out, new in
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Delivery/roll-out
Investment
Demand side
 Top-down
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Target
 Regional/national
 State
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Strategy
 Evidence based
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Partnership agreements
 Stakeholder
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Active centre
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Implementation
Spending
Supply side
 Bottom-up
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Payment-by-results
 Local
 Society
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Business Plan
 Principles based

Post-bureaucratic state
 Social Responsibility

Departments
What do we have as clinicians to help
us?
 Listening to patients
 Education /
Knowledge
 RCGP Certificate
 Code of practice
 Clinical guidelines
 Roles and
responsibilities
 Appraisals
 Toolkit
What the toolkit says?
 Competencies
necessary to
meet roles and
responsibilities
1. Joint working
2. Assessment &
testing
3. Treatment
4. Support & HR
5. Care Plans
6. Policy
Clinician influences on quality
 Patient-centred
care
 Competent
compassion
 Flexibility
 Firm but fair
boundaries
What else do we need to do to
ensure quality?
 Fight for
patients rights
 Leadership
 Ensure that
practice informs
policy and
commissioning
Working together
 Impossible to do
alone
Summary
 Change is coming
 An opportunity
 Need to ensure quality in ourselves
 Continue to fight for quality services for our
patients
[email protected]
Thank you