Andrew innes hull wsdan 30 june 2011a

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  • 1. Clinical Engagement and Telemedicine
    Church View Surgery
    Andrew Innes
  • 2. Why clinical engagement?
    Makes sense
    Viewed as self-evident in current UK health policy (1)
    “ Improvement of the performance of healthcare depends first and foremost on making a difference to the experience of patients and service users, which in turn hinges on changing the day to day decisions of doctors, nurses and other staff”.(2)
    High Quality Care for All: NHS Next Stage Review final report. London: Stationery Office, 2008.
    (2) Ham C. Improving the performance of health services: the role of clinical leadership. The Lancet 2003;361:1978–80.
  • 3. General barriers to clinical engagement
    Lack of time
    Pressure of competing demands
    Lack of understanding
    Lack of expertise
    Disinterest
    Frank prejudice
  • 4. A question of culture
  • 5. Clinical culture and the role of clinical trials
  • 6. Cum ScientiaCaritas
    First the science
    Then the caring
    Medical training
  • 7. Science
    Epistemological schism
    Mixed quality (better in heart failure than COPD)
    Problems of considering cost effectiveness
  • 8. Caritas
    Antithesis of personalized healthcare?
    Remote
    Cost-cutting?
    Concerns about clinical governance and safety
  • 9. Overcoming barriers to telehealth – What excites clinicians?
    Improved quality of care – an additional window on a patient’s problems
    Improved clinical relationship with patients
    Improved efficiency
    Improved cost effectiveness
    A different way of working
    Application of technology
  • 10. Overcoming barriers to telehealth – What excites patients?
    Empowerment – the expert patient
    Effective, timely and safer care
    Improved access
  • 11. Why must clinicians change?
    Tsunami of long term conditions
    LTC affect 31% of the population and account for 52% of all GP appointments and 65% of all OPD
    Around a 25% in the numbers of patients with LTCs over next 25 years
    Changing practice with risk tools and community MDT
  • 12. Key components of resolving clinical engagement
    Adopt a communication strategy that addresses the problems and the benefits in terms that clinicians understand
    Good clinical evidence of benefit
    Prioritise clinical domains rather than management targets
    Local “Champions”
    Funding – pump prime through enhanced service or QOF mechanisms. NB. Little evidence to support much of what QOF does and yet GP’s perform well in this framework
  • 13. Thank you
    Any questions?
    andrewinnes@nhs.net