A Clinician's View from Secondary Care


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A Clinician's View from Secondary Care

  1. 1. A Clinician’s View from Secondary Care Professor John Williams Director Welsh Assembly Government Office for Research and Development (WORD)
  2. 2. I welcome this programme - particularly …. <ul><li>the focus on the patient, and support for patient-professional interaction </li></ul><ul><li>the commitment to an evidence based approach </li></ul><ul><li>the unequivocal endorsement given by the Welsh Assembly Government </li></ul>
  3. 3. What will it mean? <ul><li>Firstly…... </li></ul>
  4. 4. Patients and professionals will no longer have to cope with this…….
  5. 5. … ...records that are…... <ul><li>fat, disorganised, </li></ul><ul><li>episode focused </li></ul><ul><li>different everywhere </li></ul><ul><li>not integrated </li></ul><ul><li>often duplicated </li></ul><ul><li>often missing, and.. </li></ul>
  6. 6. … ..a wasted source of invaluable data for…... <ul><li>shared decision making </li></ul><ul><li>personal assessment </li></ul><ul><li>planning new services </li></ul><ul><li>monitoring quality </li></ul><ul><li>monitoring experience </li></ul><ul><li>clinical and health services research </li></ul>
  7. 7. For example…... <ul><li>We could capture and monitor patient quality of life as a routine to inform shared decisions </li></ul><ul><li>Now a high priority for the HTA National Research Methodology Programme </li></ul><ul><li>We could conduct large scale randomised trials using routinely collected clinical data </li></ul><ul><li>Williams JG et al Health Technology Assessment 2003;7:No26 </li></ul><ul><li>We could understand more reliably the performance of the service </li></ul><ul><li>Is the NHS getting better or worse? We need better data to answer the question Smith R BMJ 2003;327:1239-41 </li></ul>
  8. 8. Secondly, we will be able to modernise... <ul><li>The provision of healthcare in the future will be radically different, through </li></ul><ul><ul><li>Better informed patients </li></ul></ul><ul><ul><li>Remote consultation </li></ul></ul><ul><ul><li>Changing roles and responsibilities </li></ul></ul><ul><ul><li>Virtual teams </li></ul></ul><ul><ul><li>New, simpler processes </li></ul></ul><ul><li>We will not be able to achieve this without modernising the infrastructure for records, communication and administrative processes </li></ul>
  9. 9. Thirdly, it will mean professionals embracing change…. <ul><li>New standards for data collection and communication </li></ul><ul><li>New ways of working </li></ul><ul><li>Underpinned by evidence wherever possible </li></ul><ul><li>Facilitated by managers who are also prepared to change </li></ul>
  10. 10. What do my colleagues think? <ul><li>We have just completed a survey of active members of the British Society of Gastroenterology. </li></ul><ul><li>124 responses were received from 98 acute trusts in England and Wales </li></ul>
  11. 11. Q8c: Does the medical record include documentation on multi-disciplinary team meetings and telephone discussions? Source: National Survey of British Society of Gastroenterology Members November 2003 n = 124
  12. 12. Q8e: How important are these functions to your clinical practice? Source: National Survey of British Society of Gastroenterology Members November 2003 n = 124
  13. 13. Q16: How important to your clinical practice is the ability to structure clinical information under nationally defined headings? Source: National Survey of British Society of Gastroenterology Members November 2003 n = 124
  14. 14. Finally, it must be evidence based <ul><li>This programme has a Research & Evaluation Group which will ensure developments are </li></ul><ul><ul><li>based on the latest evidence </li></ul></ul><ul><ul><li>properly evaluated </li></ul></ul><ul><ul><li>designed to yield evidence when appropriate </li></ul></ul><ul><li>This is a model which should be applied to all national and local initiatives </li></ul>
  15. 15. In summary - we can now hope for…. <ul><li>Patients fully informed about treatment options and the likely outcome </li></ul><ul><li>Practitioners fully informed about the problems, views, preferences and quality of life of the patient </li></ul><ul><li>Patients at the centre of virtual clinical teams communicating electronically </li></ul><ul><li>Practitioners fully aware of their own performance </li></ul><ul><li>New services unconstrained by organisational boundaries and interfaces </li></ul><ul><li>Evidence based innovation and developments </li></ul>