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The journey -

The Map of Medicine for GP referrals programme’s aim is to reduce inappropriate referrals by creating greater clarity of understanding between GPs and consultants, not only about how to refer appropriately but also about what can reasonably and safely be done in primary care before referral. The vision of the programme is ‘right care, right place, first time.’ The Map of Medicine itself is an online set of algorithms based on national best practice.  It allows the user to create a central repository of care pathways for a variety of conditions for use by GPs, building in local referral criteria and pragmatic explanations of NICE guidance.  

Outcomes

The programme now has the highest number -114 – of properly localised pathways in the country, as well as the country’s highest GP usage.  Future ambitions include referral forms which will interface with GPs’ systems and automatically populate.  Also planned is a checklist function for GPs which, it is hoped, will help to drive up the overall quality of referrals.  All local service information will be included, increasing patient choice, and video links are being developed, some to aid diagnosis and some for patient information, explaining the risks and benefits of key health decisions.  

Patient setting

In-patient Out-patient   X Community based
Mental health Chronic illness Cross-systems   X
 

Clinical area

Staying healthy Maternity and newborn Children and young people   X Acute care   X
Planned care   X Mental health   X Long-term conditions   X End of life
 

Information, tools and techniques used

No formal change model has been used to deliver the programme.  Instead the team’s approach has evolved to work pragmatically around existing structures.  A Lean approach has underpinned its project management, as well as an organising approach to encourage GP participation based on the thinking of Marshall Ganz. The approach has been strongly collaborative, with hospital consultants and doctors working with GPs and other clinicians in the community, with input from physiotherapists, pharmacists, dieticians and other health professionals.  

Geography

The programme extends across South West Hampshire.  It affects all organisations, NHS and non-NHS, to which GPs refer patients.  

Timescale

The first tranche of some ten local pathways was launched to GPs in August 2010. The next significant milestone was in May 2011 when there was a major shift in usage from under 1,000 GP hits per month to more than 1,500.  This upwards trend has continued since then.  

Contact details and further information

Cathy Price, NETSCC Consultant Advisor:- c.m.price@soton.ac.uk

[post_title] => Map of Medicine for GP referrals [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => map-of-medicine-for-gp-referrals [to_ping] => [pinged] => [post_modified] => 2013-01-16 14:12:11 [post_modified_gmt] => 2013-01-16 14:12:11 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3324 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 3326 [post_author] => 8 [post_date] => 2012-12-28 13:55:52 [post_date_gmt] => 2012-12-28 13:55:52 [post_content] =>

The journey -

The Wessex Deanery appraisal and revalidation service programme’s purpose was to set up and run a comprehensive medical appraisal service; appraisals were previously carried out by the PCT.  The aim was to deliver consistent and effective medical appraisals and support to doctors and, by doing this, to drive quality improvements in patient care.  Doctors were given an annual opportunity to have protected time with an expert colleague to review and reflect on their performance and practice. The deanery’s appraisal and revalidation service has aimed to create a culture change in the perception of appraisal and revalidation based on the belief that doctors will get more out of the process if they put more in and have better trained and supported appraisers.  

Outcomes

The deanery now delivers about 2,000 medical appraisals per year through about 200 medical appraisers, delivering consistent and valuable appraisals across different healthcare models. It runs appraiser training and support that was described as “exemplary” by an external quality assurance report. Also, by collating and sharing the educational needs highlighted by appraisals, the deanery has created a sharper focus for educational provision. It has also trained appraisers in mentoring skills and created a separate cohort of trained mentors for support and remediation work. The change has also brought closer alignment of medical educators with doctors and has reduced cynicism about the appraisal system and its value.  

Patient setting

In-patient   X Out-patient   X Community based   X
Mental health   X Chronic illness   X Cross-systems   X
 

Clinical area

Staying healthy  X Maternity and newborn  X Children and young people   X Acute care   X
Planned care  X Mental health   X Long-term conditions   X End of life  X
 

Information, tools and techniques used

No information available.  

Geography

The geographic area is principally the Wessex Area plus the Channel Islands with national networks across the UK.  

Timescale

Following three years as a pilot the project was mainstreamed into the Wessex Deanery GP school in April 2010.  

Contact details and further information

Dr Susi Caesar, Service Lead: susi.caesar@wessexdeanery.nhs.uk
[post_title] => Wessex Deanery Appraisal and Revalidation Service [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => wessex-deanery-appraisal-and-revalidation-service [to_ping] => [pinged] => [post_modified] => 2013-01-16 14:13:37 [post_modified_gmt] => 2013-01-16 14:13:37 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3326 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 3325 [post_author] => 8 [post_date] => 2012-12-28 13:42:57 [post_date_gmt] => 2012-12-28 13:42:57 [post_content] =>

The journey -

Responding to a lack of internal capability and capacity, nine PCTs came together to collaborate on obtaining specialist analytical support to gather and use data.  This data covered three areas: understanding the health needs of the population; informing service redesign; and indentifying performance indicators to manage providers following commissioning.  The programme team decided to contract a third party to deliver this support: Tribal (now known as Capita).  

Outcomes

Overall the programme has demonstrated good return on investment, although it has proved somewhat less good value for larger PCTs with more internal capability. Over the last year, the scale of the contract with the third party supplier has been reduced as PCT’s understanding of which tools and services will be most useful to support clinical led commissioning has grown. Learning includes a richer understanding of what’s good to provide locally, what at a mid-size geography and what at scale; and that better information and analysis is not enough. In order to use information effectively, change management must also happen.  

Patient setting

In-patient Out-patient Community based
Mental health Chronic illness Cross-systems   X
 

Clinical area

Staying healthy  X Maternity and newborn   X Children and young people   X Acute care   X
Planned care   X Mental health   X Long-term conditions   X End of life  X
 

Information, tools and techniques used

The programme has mainly involved the provision of analytical tools and services to give commissioners access to new types of information. However, an important part of the programme has been to support PCTs in accessing and interpreting this new information to support decision making and to drive intelligence-led commissioning.  

Geography

The programme involved the nine PCTs of the NHS South Central area, which stretches from Milton Keynes to the Isle of Wight.  

Timescale

The third party supplier was contracted in 2010 for four years.  This has now reduced to three to coincide with CCGs going operational in April 2013.  

Contact details and further information

Alan Thompson, Programme Manager, South Central PCT Alliance: Alan.thompson@hampshire.nhs.uk

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The journey -

This programme has two main aims.  The first is to integrate social care within the NHS for community and domiciliary services.  This has led to the appointment of a joint manager across community health service social care services.  Another aim is to manage radical change of the whole social care service, responding to resource reduction of 20{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} over the next 3 years.  This change will include redefining the service personalisation, enablement and service integration as well as achieving improved commissioning.  

Outcomes

As part of the integration programme, key relationships have been established and conditions have been created where people can take bold decisions.  The transformation of the social care service is at too early a stage for main outcomes to be seen, but already there is much closer management and delivery of services.  

Patient setting

In-patient Out-patient Community based   x
Mental health Chronic illness Cross-systems   x
 

Clinical area

Staying healthy Maternity and newborn Children and young people   x Acute care
Planned care Mental health   x Long-term conditions   x End of life
 

Information, tools and techniques used

No information available  

Geography

The programme has implications for the whole of Kent but mainly concerns Dover and Thanet, Kent and Medway PCT and the Kent community health trust.  

Timescale

The programme has been underway since 2010 and is still ongoing.  

Contact details and further information

James Lampert, Project Manager Tel: 01622 671411 [post_title] => Integrating community health service social care services [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => integrating-community-health-service-social-care-services [to_ping] => [pinged] => [post_modified] => 2013-01-16 14:16:40 [post_modified_gmt] => 2013-01-16 14:16:40 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3322 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 3321 [post_author] => 8 [post_date] => 2012-12-28 13:15:17 [post_date_gmt] => 2012-12-28 13:15:17 [post_content] =>

The journey -

The High Impact Pathways programme was developed to reduce patient waiting times in NHS South Central to 18 weeks, a target set by the Department of Health. A more creative, sustainable solution had to be devised which would enable the ten primary care trusts across the region to meet this target. The programme aimed to inform and share knowledge across the trusts. Based on the principles of LEAN, (an improvement methodology which focuses on process improvement, reduction of waste and efficiency), the programme involved an undertaking from each organisation involved to re-design and commit resources to three self-selected patient pathways. The scale and transformational nature of the programme was considered highly innovative. Experts from two external management consultancies were employed, in the early stages, to provide leadership for the first of the pathways and later to offer guidance to NHS staff moving into leadership roles. The focus was primarily on quality and the change became embedded across the PCTs as a new way of working.

Outcomes

The programme achieved a significant saving in patient waiting times. Perhaps more significant is the step change in how those involved perceive improvement itself. The project lead has described how ‘the scene was set for a new sense of improvement culture’, with the principles of LEAN methodology becoming embedded. The most significant achievements have been attributed at a local level to strong project leadership and a cultural climate which was receptive to change. Although ultimately not all of the High Impact Pathways were implemented, the overriding feeling is one of an increased appetite for streamlining, reducing waste and standardising processes.

Patient setting

In-patient   X Out-patient   X Community based
Mental health Chronic illness Cross-systems   X

Clinical area

Staying healthy   X

Maternity and newborn  X

Children and young people  X

Acute care  X

Planned care  X

Mental health

Long-term conditions

End of life

 

Information, tools and techniques used

The programme used the principles of LEAN methodology to improve efficiency in all areas.

Geography

Across the ten primary care trusts within South Central.

Timescale

High Impact Pathways was implemented over the course of one year, beginning in late summer 2007. This included an initial period of engagement at executive level and training, primarily for project managers.

Contact details and further information

Peter Loomes led the project. For any queries around the National Dementia Strategy please contact Julie Kerry on 07925 448319 or julie.kerry@southcentral.nhs.uk

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The journey -

The Map of Medicine for GP referrals programme’s aim is to reduce inappropriate referrals by creating greater clarity of understanding between GPs and consultants, not only about how to refer appropriately but also about what can reasonably and safely be done in primary care before referral. The vision of the programme is ‘right care, right place, first time.’ The Map of Medicine itself is an online set of algorithms based on national best practice.  It allows the user to create a central repository of care pathways for a variety of conditions for use by GPs, building in local referral criteria and pragmatic explanations of NICE guidance.  

Outcomes

The programme now has the highest number -114 – of properly localised pathways in the country, as well as the country’s highest GP usage.  Future ambitions include referral forms which will interface with GPs’ systems and automatically populate.  Also planned is a checklist function for GPs which, it is hoped, will help to drive up the overall quality of referrals.  All local service information will be included, increasing patient choice, and video links are being developed, some to aid diagnosis and some for patient information, explaining the risks and benefits of key health decisions.  

Patient setting

In-patient Out-patient   X Community based
Mental health Chronic illness Cross-systems   X
 

Clinical area

Staying healthy Maternity and newborn Children and young people   X Acute care   X
Planned care   X Mental health   X Long-term conditions   X End of life
 

Information, tools and techniques used

No formal change model has been used to deliver the programme.  Instead the team’s approach has evolved to work pragmatically around existing structures.  A Lean approach has underpinned its project management, as well as an organising approach to encourage GP participation based on the thinking of Marshall Ganz. The approach has been strongly collaborative, with hospital consultants and doctors working with GPs and other clinicians in the community, with input from physiotherapists, pharmacists, dieticians and other health professionals.  

Geography

The programme extends across South West Hampshire.  It affects all organisations, NHS and non-NHS, to which GPs refer patients.  

Timescale

The first tranche of some ten local pathways was launched to GPs in August 2010. The next significant milestone was in May 2011 when there was a major shift in usage from under 1,000 GP hits per month to more than 1,500.  This upwards trend has continued since then.  

Contact details and further information

Cathy Price, NETSCC Consultant Advisor:- c.m.price@soton.ac.uk

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Category: Children and young people

Map of Medicine for GP referrals

The journey – The Map of Medicine for GP referrals programme’s aim is to reduce inappropriate referrals by creating greater clarity of understanding between GPs and consultants, not only about how to refer appropriately but also about what can reasonably and safely be done in primary care before referral. The vision of the programme is […]

Posted on Dec 28th Cat: , , , , , , , , , Comments: Comments are off for this post

Wessex Deanery Appraisal and Revalidation Service

The journey – The Wessex Deanery appraisal and revalidation service programme’s purpose was to set up and run a comprehensive medical appraisal service; appraisals were previously carried out by the PCT.  The aim was to deliver consistent and effective medical appraisals and support to doctors and, by doing this, to drive quality improvements in patient […]

Posted on Dec 28th Cat: , , , , , , , , , , , , , , , , , Tags: Comments: Comments are off for this post

South Central PCT Alliance

The journey – Responding to a lack of internal capability and capacity, nine PCTs came together to collaborate on obtaining specialist analytical support to gather and use data.  This data covered three areas: understanding the health needs of the population; informing service redesign; and indentifying performance indicators to manage providers following commissioning.  The programme team […]

Posted on Dec 28th Cat: , , , , , , , , , , , Comments: Comments are off for this post

Integrating community health service social care services

The journey – This programme has two main aims.  The first is to integrate social care within the NHS for community and domiciliary services.  This has led to the appointment of a joint manager across community health service social care services.  Another aim is to manage radical change of the whole social care service, responding […]

Posted on Dec 28th Cat: , , , , , , , , Tags: , Comments: Comments are off for this post

High Impact Pathways

The journey – The High Impact Pathways programme was developed to reduce patient waiting times in NHS South Central to 18 weeks, a target set by the Department of Health. A more creative, sustainable solution had to be devised which would enable the ten primary care trusts across the region to meet this target. The […]

Posted on Dec 28th Cat: , , , , , , , , , , Tags: Comments: Comments are off for this post