Thursday, 9 February 2017

Continuity of care - who needs it!

Ladies and Gentlemen I have some good news and some bad news and then some better news!
Good news the NHS is set up to cope with anything: If you were Tim Peake, Britain's Astronaut, hurtling towards the earth in a Soyuz capsule to land in Kazakhstan and you were injured during that landing the NHS was already prepared. Yes if Tim had been injured his GP would have been able to add the Read Code T55z0 'Spacecraft accident NOS, occupant of spacecraft injured' to his medical record. Had, heaven forbid, his parachute failed, the NHS was ready for that too, the code is X711Z Failure of parachute on descent. Indeed the NHS would have been code ready if the Soyuz capsule re-entry motors had failed or they had suffered a loss of air supply or even if they had been hit by a passing passenger jet or meteorite. Yes we have spacecraft accidents covered - there are 57 varieties of code for spacecraft accidents. Or maybe you have been bitten by a hippoptamus - we have a code for that too X717Z. Or maybe your GP wants to record your pasta intake Ub0A3.

Bad news: But suppose you are in that highly unusual situation of being an older person with multiple chronic diseases and needing the personal continuity of being seen by the same clinician each time, not only for your own safety but your sanity too. 'If I have to tell another doctor the same story again I shall go mad!' Supposing your healthcare record needs to flag that up? We don't have a code for that!!! No not one. Typing 'continuity' into a read code search engine will give you codes for 'disorders in continuity of bone or heart valves' but nothing on continuity of personal care! The nearest you can get is the code XaKZN Provision of continuing care, but even this is more about Continuing Healthcare Funding than continuity of care. Our coding system has evolved to reflect successive governments' obsession with access to appointments to the exclusion of continuity despite a wealth of evidence that continuity delivers on quality, cost, safety and patient satisfaction. There are hundreds of codes about getting, making, attending, not attending or cancelling appointments by any number of different providers! So if you are a politican remember patients love continuity and those patients tend to be older and those older patients turn out at elections. #justsaying If you are an NHS Finance person remember patients who get good continuity take their medications better and tend to choose cheaper less invasive Rx options when discussing risks with their trusted GP. #justsaying If you are a clinician out there we know that Drs or nurses with good continuity show better job satisfaction #justsaying. If you are a patient well you know all this we just need to listen to you! #justsaying

Better news: It doesn't have to be like that. Continuity at last features in our CCG plan. The new Snomed coding system that will eventually come into NHS actually as about 4 codes relating to continuity of care. Practices can use the Usual Doctor system to help direct patients to the best person to see them. But sometimes with teh additonal pressures we face that needs a bit of extra help. Two years ago we introduced a system whereby, using that one sort of continuity code, we flag certain patients who really do need to see the same GP as far as possible. Using that flag reception staff are then able to ensure as far as possible that when those patients need attention we direct it to the same person each time, whether its getting that doctor to ring back or booking them in to be seen or handling a medication enquiry or call from an outside agency. We have been able to show that in addition to using the usual doctor system for assigning doctors to patients and vice versa, this provides an additional improvement in continuity of care on top. Yes you can measure continuity of care - it's just that those who set the rules have chosen not to. In addition we are experimenting with developing virtual teams to help prevent patients getting lost in what is now a bigger organisation. So let's start organising and commissioning and regulating and funding for continuity of personal care...