Joint Working workshop
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The document discusses a quality premium program that rewards clinical commissioning groups for improvements in quality and outcomes. It explains that the premium is based on performance on 4 national measures and 3 local measures selected by each CCG. The national measures relate to reducing mortality, emergency admissions, patient experience, and infections. For a sample CCG, emergency admissions are a major issue, with over 56,000 total admissions last year. Selecting local measures that help achieve the national measures, like reducing emergency admissions, could maximize the CCG's quality premium payment.
Joint Working workshop
- 1. Joint Working Workshop The “7 Step framework” Sharing best practice Identifying opportunities using real world data Kevin Blakemore, National Partnership Manager| ABPI Helen Wheeler, National Project Manager | Sanofi Hassan Chaudhury, Director of Health Intelligence | Health iQ
- 3. Quick Start Guide – May 2012
- 4. Flow Chart
- 5. 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
- 6. The Charles Town Project- Having the confidence to share gives us confidence to learn Helen Wheeler, National Project Manager | Sanofi
- 7. 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 )”project Goals •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.
- 8. 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.
- 9. 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: Project Methodology
- 10. 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.
- 11. 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
- 12. 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
- 13. What went wrong: key Communication between Stakeholders No real Equity of Voice
- 14. 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
- 15. 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”
- 16. 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
- 17. 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?
- 18. Any Questions?
- 19. 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 ? Knowledge & Expertise Trust Ethics Project management Transparency Openness Respect Effectiveness Support
- 20. Identifying Joint Working Opportunities- 7d Using real world data Hassan Chaudhury, Director of Health Intelligence | Health iQ
- 21. 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)
- 22. 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.
- 23. 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.
- 24. 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
- 25. 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.
- 26. 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
- 27. 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.
- 28. 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
- 29. Closing Remarks7d Outcomes and Feedback Karen Thomas, Regional Partnership Manager London | ABPI
- 30. What do you see?
- 32. To achieve……. “ High quality care for all, for now and for the future generations” NHS England