Q5. Currently, the Scottish island of Granta has three GP surgeries. These surgeries offer a range of services. *A GP/doctor's surgery provides a wide range of family health services including, for example, advice on health problems, vaccinations, examinations and treatment, prescriptions for medicines. It also makes referrals to other health services. The local Health Board are concerned about the running costs of the buildings and the need to refurbish one of them as it is in a poor state of repair. They also think that the administrative costs of running three separate small surgeries could be improved by merging them into one or two practices. These savings could be used to pay for 1 more GP on the island or 2 community healthcare workers. The smallest of the three centres currently operates reduced hours, and the GP is often the only person in the building. When she is called out to do house calls, sometimes there is no one to manage the surgery. The distances between these GP surgeries, and the lack of public transport provision, mean that it is difficult for many patients to travel further, especially as many of the island residents are old. One of the GPs has recently completed a MBA, during which she learned about MCDA and thought it would be helpful to try to use it to structure thinking with regard to which of five potential options would be the most appropriate for the combined community The 5 potential options are: 1 3 Option All facilities are co-located at A All at A 2 All facilities are co-located at B All at B All facilities are co-located at A but 2 clinics a week are held A+B&C at each of B&C (at these times there fewer doctors at A) clinics 4 All facilities are co-located at B but 2 clinics a week are held B+ A&C at each of A&C (at these times there fewer doctors at B) clinics The current arrangements continue - i.e. 3 separate 3 surgeries surgeries at A,B,C (ABC) Drawing on initial discussions with problem stakeholders, she created an initial value tree and used it to carry out a rough analysis of the options which had been identified. 5 The value tree and some of the output from that analysis is shown below (Figures Q5a-d). Figure Q5a Value tree ValS-A Costs Quality of care Development costs (1,000) Operating costs Range of services Quality of staff Hours of opening Expected travel times Special needs Location of GP services Accessibility Facilities On site pharmacy Children's play area Cafe Co-located physiotherapist Figure Q5b Scoring profile Score Profile Across Tree Best -Alat A -A+B&C clinics -3 surgeries -B+C&A clinics Worst Development Range of Hours of opening Special needs Children's play Operating costs Quality of staff Expected travel On site pharmacy Cafe -All at B Co-located Figure Q5c Overall scores and upper level criteria scoring profile X Location of GP services: Profiles... 100 -All at A Location of GP services: Scores X A-B&C clinics 100 50 0 All at A A+B&C clinics 3 surgeries All at B B+C&A clinics B+C&A clinics TII -3 surgeries IN -All at B 0 Costs Accessibility Quality of care Facilities Figure Q5d Sensitivity plots x Accessibility / Location of GP services 100. Location of GP services Costs / Location of GP services 100 Location of GP services -3 surgeries -A-B&C clinics -All at A -B-C&A clinics -3 surgeries B+C&A clinics A+B&C clinics All at B All at B -All at A 1.0 Costs 0 0.5 0.5 1.0 Accessibility (a) Comment on the structure of the value tree in Figure Q5a above. To what extent does it conform to the characteristics of a good value tree? Describe any changes you would make to the tree to enhance it. Use the information in Figure Q5a to briefly describe what matters to the problem stakeholders in question. (b) Write a brief report which summarises the output of the analysis and contains your recommendations for the decision maker(s) at the local Health Board. Q5. Currently, the Scottish island of Granta has three GP surgeries. These surgeries offer a range of services. *A GP/doctor's surgery provides a wide range of family health services including, for example, advice on health problems, vaccinations, examinations and treatment, prescriptions for medicines. It also makes referrals to other health services. The local Health Board are concerned about the running costs of the buildings and the need to refurbish one of them as it is in a poor state of repair. They also think that the administrative costs of running three separate small surgeries could be improved by merging them into one or two practices. These savings could be used to pay for 1 more GP on the island or 2 community healthcare workers. The smallest of the three centres currently operates reduced hours, and the GP is often the only person in the building. When she is called out to do house calls, sometimes there is no one to manage the surgery. The distances between these GP surgeries, and the lack of public transport provision, mean that it is difficult for many patients to travel further, especially as many of the island residents are old. One of the GPs has recently completed a MBA, during which she learned about MCDA and thought it would be helpful to try to use it to structure thinking with regard to which of five potential options would be the most appropriate for the combined community The 5 potential options are: 1 3 Option All facilities are co-located at A All at A 2 All facilities are co-located at B All at B All facilities are co-located at A but 2 clinics a week are held A+B&C at each of B&C (at these times there fewer doctors at A) clinics 4 All facilities are co-located at B but 2 clinics a week are held B+ A&C at each of A&C (at these times there fewer doctors at B) clinics The current arrangements continue - i.e. 3 separate 3 surgeries surgeries at A,B,C (ABC) Drawing on initial discussions with problem stakeholders, she created an initial value tree and used it to carry out a rough analysis of the options which had been identified. 5 The value tree and some of the output from that analysis is shown below (Figures Q5a-d). Figure Q5a Value tree ValS-A Costs Quality of care Development costs (1,000) Operating costs Range of services Quality of staff Hours of opening Expected travel times Special needs Location of GP services Accessibility Facilities On site pharmacy Children's play area Cafe Co-located physiotherapist Figure Q5b Scoring profile Score Profile Across Tree Best -Alat A -A+B&C clinics -3 surgeries -B+C&A clinics Worst Development Range of Hours of opening Special needs Children's play Operating costs Quality of staff Expected travel On site pharmacy Cafe -All at B Co-located Figure Q5c Overall scores and upper level criteria scoring profile X Location of GP services: Profiles... 100 -All at A Location of GP services: Scores X A-B&C clinics 100 50 0 All at A A+B&C clinics 3 surgeries All at B B+C&A clinics B+C&A clinics TII -3 surgeries IN -All at B 0 Costs Accessibility Quality of care Facilities Figure Q5d Sensitivity plots x Accessibility / Location of GP services 100. Location of GP services Costs / Location of GP services 100 Location of GP services -3 surgeries -A-B&C clinics -All at A -B-C&A clinics -3 surgeries B+C&A clinics A+B&C clinics All at B All at B -All at A 1.0 Costs 0 0.5 0.5 1.0 Accessibility (a) Comment on the structure of the value tree in Figure Q5a above. To what extent does it conform to the characteristics of a good value tree? Describe any changes you would make to the tree to enhance it. Use the information in Figure Q5a to briefly describe what matters to the problem stakeholders in question. (b) Write a brief report which summarises the output of the analysis and contains your recommendations for the decision maker(s) at the local Health Board