Joint Working WorkshopThe “7 Step framework”Sharing best practiceIdentifying opportunities using real world dataKevin Blakemore, National Partnership Manager| ABPIHelen Wheeler, National Project Manager | SanofiHassan Chaudhury, Director of Health Intelligence | Health iQ

Our common goal

Win:Win:Win:Win:Win

Public

NHS

Academia

Voluntary Sector

Industry

Social

Care

Quick Start Guide – May 2012

Flow Chart

Promotion Joint Working

MEGS Sponsorship

For patient benefit Yes Yes Yes Yes

NHS/Pharma company pool resources X Yes X X

Pharma company investment Yes Yes Yes Yes

NHS investment X Yes X O

Detailed agreement in place X Yes X X

Shared commitment to successful delivery

X Yes Yes Yes

Details of the agreement are made public

X Yes O X

Prospective ROI Yes Yes X X

Outcomes must be measured X Yes O X

The Charles Town Project-

Having the confidence to share gives us confidence to learnHelen Wheeler, National Project Manager | Sanofi

Original Proposal• Aim was to form a collaborative group to undertake a programme of activities developed to address the health issues around Diabetes • To be known collectively as the “NHS Charles Town and Industry Maximising Resources and Outcomes in Diabetes (Concord )”projectGoals• To ensure delivery of high quality diabetes care• To reduce diabetes health inequalities • Improve outcomes for all patients with diabetes in Charles Town regardless of where they live.

Objectives of the Project

1) To reduce the rate / number of avoidable admissions to hospital for patients with diabetes and diabetes related illness. 

2) To reduce the rate of inappropriate / avoidable utilisation of emergency services for people with diabetes related illnesses.  

3) To develop and implement a coherent care planning approach to the management of people with diabetes across primary, secondary and community services, which ensures that all patients have the opportunity to be actively involved in decisions about how their diabetes is managed.

4) To work in partnership with all stakeholders including the pharmaceutical industry, in an innovative and inclusive way throughout the project to achieve outcomes which benefit patients with diabetes in Charles Town

5) To ensure that all activities are developed and implemented in a way which improves the quality, efficiency and cost effectiveness of care in line with national QIPP objectives.

 

Primary Care Clinician /Secondary Care Clinician

Primary Care Nurse (with diabetes expertise)

Community Pharmacy/PBC cluster managers and clinical leads

Charles Town “City Health” (provider arm) /NHS Charles Town Health promotion

NHS Charles Town Public Health/ NHS Charles Town Clinical Audit/ NHS Charles Town Commissioning Directorate

Pharmaceutical Industry (one seat per organisation)

NHS Charles Town Primary Care Contracting/NHS Charles Town Medicines Management

+ 8 industry partners

Patient Representative

Developed and managed in partnership with the ABPI Outreach Project who formed a group of interested member companies to act as equal stakeholders throughout. PCT-led project managed by a multi-professional multi-agency steering group consisting of a lead from each of the following stakeholder groups: 

In a Nutshell

• In-Patient Audit commissioned by the LOCAL IMPLEMENTATION GROUP

• Driven through a PROJECT GROUP

• Managed by a highly experienced independent PROJECT MANAGER paid by the Project sponsors through the budget.

Different stakeholders theoretically agreed with the project aims and rationale

Equity of industry and NHS

Endorsement of the Project from a high level (Chief Executive)

Collaborative concept was good

Excellent launch - with motivational and national figures in support

Innovation project based upon a well established and successful project that the Project Manager had led previously

In theory should have just replicated the last CHD project

PM was a third party and theoretically objective and skilled

What worked well

Became a duel between commissioning lead/clinical leads and

project lead

Scepticism between NHS and

industry had not left the room

Industry was diluted - too

many partners

Skill set in the project team not utilised

Industry had much of the data that

was needed

Level of investment did not

= level of voice

Project lead became a facilitator between

Industry & NHS - should have been left behind

once partnership agreed

Poor dynamics

Too controlled and inhibited freedom

of speech

Declaration of interest to other industry outside of

the group

Did the Project team fully

understand the therapy area?

No clear timelines

What did not go so well

What went wrong: key

Communication between

Stakeholders

No real Equity of Voice

Outcomes

Questions were asked around:

– Freedom of entry - became a closed shop

– Competition Law

– Lack of transparency due to communication between the PM and the LIG

– Industry skill set not maximised/ Project Management experience

– Loss of confidence by the LIG

– LIG pulled out money - returned to industry

What needs to happen– The Patient must be at the centre of all this otherwise what is it all about?

– Old ways need to be left behind – innovation trust need to be our future honesty

– Some one needs to step up and say:

“Is this project going to lead to better Health outcomes for the Patient?”

if the answer is yes

“Have we as potential partners got the right resource and capacity together to drive this through”?

if the answer is yes

“well let’s just get on with it”

Where are we now?

• LIG still see the Value in the Project

• DUK still see value in the project

• Industry has much of the data that is needed as well as the skill set and capacity to project manage

• Access still difficult between Secondary Care and Industry

• SC still very dominant and protective - this needs to change

• Patients still in the same place and could be better serviced- no body won and the war keeps raging

Ensure a mechanism for genuine input

Use a more effective channel of communication to the LIG

Improve the equity of voice - but perhaps less voices??

Have clear terms of references

Better governance

Make a safe environment for all stakeholders to give an honest declaration of interest- what do you want out of the project?- how as a company are you going to measure success?Ensure that the project is not dominated

Identify and utilise what you already have before buying more

Trust - do not move forward without this

How would we do this differently?

Any Questions?

Group Work

1. How could some of these issues have been avoided? Refer to hand-out

2. How could the “7 Step framework” have been used?

3. Have you participated in a joint working project that was unsuccessful?a. why was it unsuccessful?b. what did you learn from it?

4. Of the 9 indicators for joint working, which are top 3 most important and why? a. Are there any other indicators that should be included ?

4. Have you participated in a joint working project that was unsuccessful?a. why was it unsuccessfulb. what did you learn from it?

Identifying Joint Working Opportunities-

7d

Using real world data

Hassan Chaudhury, Director of Health Intelligence | Health iQ

CCG Data

Quick Facts:

– Not in London (somewhere in the Midlands)– Ethnically diverse. – Population of 600,000 - which is rapidly rising. – Over 50 GP Practices. – Higher than average deprivation. – Lower than average life expectancy with a lot of variation across the CCG. – Prescribing costs have gone up faster than expected as have emergency

admissions. – Mental health costs are very high.

• It has had discussions on choosing its 3 local measures for the Quality Premium

(c.f. http://www.england.nhs.uk/wp-content/uploads/2013/05/qual-premium.pdf)

What is the Quality Premium?

Four Areas to explain:

1.The ‘quality premium’ is intended to reward clinical commissioning groups

(CCGs) for improvements in the quality of the services that they commission and

for associated improvements in health outcomes and reducing inequalities.

2.The quality premium paid to CCGs in 2014/15 – to reflect the quality of the

health services commissioned by them in 2013/14 – will be based on:

four national measures and three local measures.

What is the Quality Premium?

3. The four national measures, all of which are based on measures in the NHS Outcomes Framework, are:

1) reducing potential years of lives lost through amenable mortality (12.5 per cent of quality premium): the overarching objective for Domain 1 of the NHS Outcomes Framework;

2) reducing avoidable emergency admissions (25 per cent of quality premium): a composite measure drawn from four measures in Domains 2 and 3 of the NHS Outcomes Framework;

3) ensuring roll-out of the Friends and Family Test and improving patient experience of hospital services (12.5 per cent of quality premium), based on one of the overarching objectives for Domain 4 of the NHS Outcomes Framework

4) preventing healthcare associated infections (12.5 per cent of quality premium), based on one of the objectives for Domain 5 of the NHS Outcomes Framework.

What is the Quality Premium?

4. The three local measures should be based on local priorities such as those identified in joint health and wellbeing strategies.

These will be agreed by individual CCGs with their Health and Wellbeing Boards and with the area teams of the NHS Commissioning Board (NHS CB).

What they select must also be in line with other local priorities e.g.:- Improved Outcomes- High Quality Care- Tackle unwarranted variation and strengthen out of hospital care- Efficient and effective care pathways- Development of integrated multi agency care pathways

What is the Quality Premium?

It was decided that the three local measures would be selected to also help achieve the four national measures. The most significant of the national measures is on emergency admissions (25% of the total).

- Last year there were over 56,000 emergency admissions of local residents. - Giving a rate of 75 admissions per 1,000 people. - Of these admissions over 25,400 (44%) are repeat emergency admissions.

- Over a half of all emergency admissions arrive via the hospital’s A&E department.- Nearly a third of admissions arrive from a General Practitioner (GP)

These two methods account for nearly 90% of all emergency admissions.

- The total cost of all emergency admissions by local residents exceeded £90 million.

Group Work

Look at the following data on emergency admissions and decide: what does the data demonstrate?

Can you use this information to select areas for your local measure or is further information required?

If so, which areas would you want to focus on and what you would want to achieve?

15 Minutes

Local Measures

The 3 areas they chose were CHD, COPD and Diabetes.

ACSC emergency admissions in the CCG now make up 14.1% of all emergency hospital admissions, at a current cost of around £13 million annually.

This is what they wanted to achieve:

1. Increasing the number of patients with coronary heart disease who completed cardiac rehabilitation.

2. Increasing the number of people with COPD referred to a pulmonary rehabilitation programme.

3. Increasing the number of people with diabetes diagnosed less than a year being referred to structured education.

Let’s focus on diabetes…

• What Joint Working opportunities can you think of?

• How can parties work together for the benefit of patients, industry and the NHS?

• How would you utilise the 7 step framework?

• Would you help with setting up a Diabetes Multidisciplinary Team (NDMT) i.e. a group of specialist nurses, podiatrists, dieticians, diabetologists, and

multi-skilled practitioners: all dedicated to improving the quality of care and providing people with diabetes with the training needed to help them self-manage

• Would you help with data?

• Patient support? Perhaps help to map pathways.

The choice is yours 15 Minutes

Closing Remarks7d

Outcomes and Feedback

Karen Thomas, Regional Partnership Manager London | ABPI

What do you see?

Working in Partnership

To achieve…….

“ High quality care for all, for now and for

the future generations”

NHS England