Coventry and Warwickshire Repatriation Programme

Transcription

1 NHS Arden Commissioning Support Unit Coventry and Warwickshire Repatriation Programme Large-scale service redesign and innovation to benefit patients Arden Commissioning Support Unit worked with Coventry and Warwickshire Partnership NHS Trust to provide service redesign and innovation expertise in a large-scale project to review those patients who were receiving care from outside the area. The project aimed to bring as many patients as possible back into the area by delivering patient-focused local packages of care. Assessments of people with mental health or learning disabilities who receive treatment outside area were undertaken and solutions developed that centred around the patient. Forty patients so far have been returned to local services or had changes made to their current plan of care to ensure it meets their needs. Benefits include: Improvements in patients care and lifestyle; Improved resilience in local services; Improved cooperation across health and social care teams; and 3 million savings. The project has received positive patient feedback.

2 NHS South West Commissioning Support Unit: Pathway Navigator App A self-updating desktop application giving clinical referrers the latest information on the best clinical pathways for elective treatment To improve the clinical quality of elective processes, primary and secondary care clinical leaders in Somerset agreed the best clinical pathways for elective treatments. A challenge remained how to communicate these to the wide number of clinical referrers in an effective way? To deliver this challenge, clinicians and CCG colleagues worked with information analysts and in-house software developers from Best West Commissioning Support Unit to develop an innovative desktop application called the Pathway Navigator App. The system is a self-updating application that ensures all users have the latest information. An icon on a GP s computer screen gives instant access to information which is useful during their consultation with the patient including locally agreed interactive clinical pathways, a library of all standard referral forms, prescribing formularies, and other essential resources including printable patient leaflets and flyers. The whole project, from inception to delivery, took less than four months and began to deliver benefits immediately.

3 NHS Central Midlands Commissioning Support Unit: Management Intelligence Commissioning Support Web-based single point of access for customers to access their reporting services, data and tools Management Intelligence Commissioning Support is a web-based portal which helps commissioners to identify patients who are frequent users of secondary care services, showing dates and details of their attendances and admissions. This information helps GP practices pinpoint their frequent service users and identify the health of their population, enabling them to consider whether there are alternative care options.

4 NHS Central Southern Commissioning Support Unit: Adjusted Clinical Groups risk stratification and disease profiling tool Adjusted Clinical Groups (ACG) gives a more holistic view of the patient, incorporating primary care data as well as records of episodic or acute care Central Southern Commissioning Support Unit (CSU) is using ACG to help CCGs improve quality, outcomes and value for money. ACG is a risk stratification and disease profiling tool, designed by Johns Hopkins University, which supports clinicians in 190 GP practices in Berkshire, Buckinghamshire and Oxfordshire (covering over 1.6 million patients). The benefits of ACG are: Case management and case finding helping to identify patients who may benefit from particular services, such as community matron activities; Disease profiling understanding the patterns of multi-morbidity within practice and CCG populations; Risk profiling understanding the case mix of a population and where resources are likely to be spent; and Resource management analysing variations in case mix between GP practices.

5 NHS Cheshire and Merseyside Commissioning Support Unit: Annual Status Review Insight into the CCGs health economy to support commissioners transformational and QIPP agendas The Annual Status Review supports CCGs to transform services for patients by posing a range of questions, challenges and opportunities that support commissioners transformational and QIPP agendas. It harnesses evidence-based practice and converts this into tailored transformational interventions which deliver QIPP benefits. The ASR begins a dialogue about what matters most to the local population and helps translate that into effective and innovative commissioning through facilitating informed choices.

6 NHS Greater East Midlands Commissioning Support Unit: GEM Information, Management and Analysis Access to information and insight to transform commissioning Greater East Midlands Commissioning Support Unit (CSU) has developed GEM Information, Management and Analysis which provides a platform where commissioners can access information and insight to transform commissioning and the delivery of healthcare. More than simply data, the system, together with locally-focused analytical services, provides commissioners with the answers to key questions about health needs and helps them performance manage providers. Co-developed with clinicians GEM Information, Management and Analysis offers access to a range of key data using various technologies bringing both quality and productivity benefits and ensuring a key focus on the management and distribution of NHS resources.

7 NHS Greater Manchester Commissioning Support Unit: Greater Manchester Joint Formulary A platform to help clinicians improve the quality, safety, efficacy and cost-effectiveness of prescribing The Greater Manchester Medicines Management Group, which is part of Greater Manchester Commissioning Support Unit (CSU), has collaboratively developed a joint formulary covering a population of 2.8 million, served by 12 CCGs and 13 NHS and foundation trusts. This provides a platform for clinicians to improve the quality, safety, efficacy and cost-effectiveness of prescribing across NHS organisations. The formulary provides consistent, high quality, respected guidance, giving a rational basis for prescribing, with links to new therapies, NICE, pathways and safety alerts to keep prescribers informed. Consistency in the management of long-term conditions, as well as admission and discharge planning, is crucial for a good patient experience and the system ensures minimal variation for patients with similar conditions. The benefits include: Quality: less variation in prescribing with patients given the right medicine first time, leading to improved outcomes and increased patient safety; Innovation: one shared service with access to huge expertise allowing for new learning and ideas to be implemented, including all innovative NICE approved preparations; Productivity: reduction in wasted medication which was incorrectly prescribed; and Prevention: patients conditions are managed more effectively, leading to a reduction in emergency admissions, improved outcomes and better patient experience. The formulary also provides links to primary care procurement processes to ensure best value across primary and secondary care for those products which are clinically effective, safe and patient orientated.

8 NHS Hertfordshire and Essex Commissioning Support Unit Review of unscheduled care Better management of increasing activity/pressures in urgent care Hertfordshire and Essex Commissioning Support Unit established an urgent care network to lead the review, with membership from acute, mental health, community and ambulance trusts and social care, as well as patient representatives. It also set up an unscheduled care commissioners group within the CCG to identify local priorities for urgent care development. The review delivered: Better management of increasing activity/pressures in urgent care; More choice for patients in appropriate settings of care; The ability to plan for unscheduled care initiatives; and Sharing of best practice and learning with other CCGs.

9 NHS Kent and Medway Commissioning Support Unit: Innovation in healthcare through technology Bringing improvements for patients through the use of new technology Met Office Healthy Outlook The Healthy Outlook scheme alerts people with mild to moderate chronic obstructive pulmonary disease when weather conditions could have an adverse impact on their health. They then know to use their simple selfmanagement plan to take action to keep healthy. Kent and Medway Commissioning Support Unit (CSU) has supported five CCGs to implement this approach, which has resulted in an average 65% reduction in unplanned COPD-related admissions and saved an average of 17,000 per participating GP practice. Strategic Health Resilience Early Warning Dashboard The KMCS Business Intelligence team has worked with the University of Greenwich to develop the Strategic Health Resilience Early Warning Dashboard. The online tool brings together strategic and operational data from several organisations. It supports whole system resilience by allowing a coordinated response and decision making in relation to incidents and system pressures. Whole System Demonstrator Two thousand patients across Kent were involved in this large scale trial, where new technology was installed in patients homes to help identify whether using it would help people stay healthy and out of hospital. The results across the three areas involved showed significant reduction in people s use of planned and emergency care, reduced costs, and, most importantly, a 45% reduction in mortality rates where technology was in use. Secure videoconferencing Kent and Medway CSU is introducing video technology to create virtual patient services in a range of areas including follow-up appointments, psychology, translator services, prison healthcare, virtual wards and national specialist consultations. This will reduce costs through reducing admissions and increasing productivity, improve communication and give patients quicker access to expertise and decisions.

10 NHS North and East London Commissioning Support Unit: Multi-disciplinary review of Quality, Innovation, Productivity and Prevention plans Identifying additional areas for potential savings and quality improvements North and East London Commissioning Support Unit (CSU) has carried out multi-disciplinary QIPP reviews with several of its CCG customers. As well as being an opportunity to offer support and advice, the multidisciplinary reviews have helped strengthen relationships between the CSU and CCGs and improve the CSU s understanding of the diverse requirements and challenges of each CCG. The reviews focus on the areas the CCG feels are most important and involve a coordinated input from the contracting, quality, customer services, performance, finance and analytics teams at the CSU. Each review report provides a set of suggested actions for the CCG with the contact details of a CSU member of staff attached to each action to provide support if required. Overall, the reviews have helped CCGs to identify additional areas for potential savings and quality improvements. As a result of the reviews, several CCGs have asked the CSU to facilitate risk workshops to help them identify weaknesses in their plans and ensure they can be made more robust.

11 NHS North of England Commissioning Support Unit: Reducing variation to improve quality Using best available clinical evidence, clinical audit and GP peer review to improve outcomes and the quality of care for patients Commissioning support managers with experience in service redesign and primary care were aligned to GP practices in two CCGs with responsibility for identifying areas of unexplained variation and subsequently developing action plans to address them. Actions included supporting GPs to peer review referrals, undertake specific clinical audits or facilitate a clinical discussion based around best available evidence, such as NICE guidelines and Map of Medicine. A standard template was designed to support peer view of referrals which covered: Purpose of the referral; Quality of the referral letter; Outcome of the referral; Alternative management approaches; and Potential gaps in service, which if commissioned could reduce demand upon secondary care whilst maintaining quality. This approach was enhanced through assigning GPs to provide clinical support to the commissioning team and to lead and facilitate clinician to clinician discussions when required. Whilst measurement was largely based upon activity and spend, the underpinning approach was driven by using best available clinical evidence, clinical audit and GP peer review to improve outcomes and the quality of care for patients. Patient participation groups were also used to monitor feedback from patients following pathway changes. Intrinsic to the work with practices was the development of a range of tools to increase ownership of commissioning and to provide a mechanism for presenting data at a level that was meaningful, including: Visual control displays to present variation in spend at a GP practice level; A GP Variation in Spend (GVIS) scorecard that allows practices to compare activity and spend against other practices for outpatient referrals, inpatient and day case procedures, non-elective admissions, A&E attendances, prescribing costs; A compact between commissioning support managers, the CCG and its constituent practices was developed. This sets out agreed responsibilities between the support team and individual practices ensuring a relationship that is built upon trust and support rather than be seen as punitive;

12 Clinical Activity Assurance System (CAAS) this is a locally developed system that assists practices to identify referral variation between individual clinicians and is as a basis for peer review; and An Urgent Care Clinical Dashboard, which displays real time information from unscheduled care settings across the area, that enables practices to proactively manage patients who frequently access urgent care. At the same time secondary care analysis of local outpatient data against national benchmarking identified another area of unexplained variation. New to review ratios and consultant and consultant referrals (C2CR) varied by GP practice. This was an area of work that was built into commissioning intentions and GPs working with secondary care clinicians played an active role in reviewing pathways to ensure these were based upon best available clinical evidence. This process resulted in the reduction of unnecessary appointments and increased choice for patients who had an opportunity to consider alternative management of their condition within primary care. C2CR are now subject to a more stringent referral protocol included within the acute contract. Implementation of the policy has delivered a significant percentage reduction in the volume of consultant to consultant referrals being made within secondary care providers in comparison to previous years activity levels. An example of this is first outpatient appointments for pain, which have reduced by approximately 25% over the last 18 months. This change came about following implementation of a revised pain pathway, which was based upon applying NICE guidance. Implementation of this approach has already delivered significant reductions in average spend per head of population across all five localities but more importantly the quality of patient care has improved by ensuring pathways are based upon best available evidence. Overall, after eight months, the two CCGs had achieved a 2 million underspend against recurrent affordable demand levels.

13 NHS North Yorkshire and Humber Commissioning Support Unit: Computer Based Learning Solutions Increasing statutory and mandatory compliance with online training packages Better management of knowledge about incidents and near misses across all care settings North Yorkshire and Humber Commissioning Support Unit is developing online training to achieve the compliance levels for statutory and mandatory training, as governed by the NHS Litigation Authority and Care Quality Commission. In two years statutory and mandatory compliance levels have risen to over 75%. The service is: Intuitive and easy to access and use; Complies with all statutory and mandatory training requirements; Developed in a way to facilitate localised updating; Modular in design to fit with a blended learning approach; Scalable and flexible; and Complies with the requirements of the NHS data security policies. The CSU is currently developing learning and development packages to cover appraisal, first line management, financial and budgetary skills and agile working. The CSU has also developed a GP Soft Intelligence service that improves the management of knowledge about incidents and near misses across care settings, giving access to hard data and soft intelligence about care pathways, through the use of centralised incident reporting. The CSU acts as co-ordinator between all providers in all settings, including NHS providers, local authority providers and private providers, such as care homes, and facilitates responses and action plans.

14 NHS South Commissioning Support Unit: Integrated Care Improvement and Innovation Programme Provision of specialist consultancy support to transform service delivery South Commissioning Support Unit (CSU) is providing specialist consultancy support to a CCG, working with key stakeholders in the local health system in developing an integrated care programme which meets the medium term financial challenge, whilst maintaining high levels of service delivery. The programme will improve healthcare for local people through integration and better financial management. By using associates and in-house resources, South CSU has created a compelling offer to the CCG while reducing its project costs. The role involves identifying challenges facing the health system and facilitating the development of solutions to improve access to and the quality of care for patients. By drawing on specialist skills in healthcare analytics, finance and strategy, and through understanding the challenges and opportunities that specifically relate to the CCG, the CSU is providing effective support in the delivery of QIPP.

15 NHS South London Commissioning Support Unit: Multi-disciplinary Team Portal Self-service access to CSU information A shared multidisciplinary team portal has been identified as the tactical solution for delivering South London Commissioning Support Unit s published reports and other documents consistently to internal and external users; allowing customers self-service access to CSU information. Commissioners are also able to interact with published reports using analysis tools. Customers are able to access documents published by the business intelligence, acute contracting, finance and performance management teams. As the CCGs share published documents with ublic health departments and GP practices, the number of users is expected to increase to 5,000.