Presentation by Dr Binita Kane, Manchester University NHS Foundation Trust: Innovation in integrated care, at ECO 21 event at Haydock Park Racecourse on Thursday 12 December 2019.

1. INNOVATION IN INTEGRATED CARE

2. The Big Picture – GM
Devolution
2
Greater Manchester is the only city-region
in the country with control of its combined
health and social care budgets – a sum of
more than £6 billion annually.
Vision to deliver the greatest and fastest
possible improvement to the health and
wellbeing of the 2.8m people of Greater
Manchester.
• Decision making powers transferred
to regional level – £6bn budget for
health and social care.
• Provides the means and the
opportunity to do things differently to
meet the needs of our residents.
• Drives the integration of health and
social care.

3. Health Innovation Manchester
3
Health Innovation Manchester is a system working across
GM health research, innovation and life sciences
Commissioners
and providers
Academia and
research
Inward
Investment
National agencies
and government
Industry
Partnerships

4. Health Innovation Manchester COPD programme
4
Reducing flu &
pneumonia
Reducing tobacco
dependency
Reducing hospital
presentations
Educating patients Educating HCPs
Working collaboratively with GM health & care and industry partners to deliver the GMEC SCN
respiratory priorities:

5. Phil
1953 - 2016
5 With permission from family

6. 6
• Severe COPD (diagnosed late)
• Cigarette smoker
• Polypharmacy
• Multiple inappropriate courses oral steroids
• Multiple Co-morbidities
• Significant anxiety/panic
• Social isolation

7. Multiple isolated episodes of crisis with
no holistic view
2016
2012
2013
2014
2015

8. What if…
2016 End of life care
2000 Active case finding at GP
2008 Diagnosis of COPD
2012 First Hospital Admission
2015 Recurrent Hospital Admissions

9. HInM vision for COPD new model of care
9
We need a radical shift in how COPD patients are managed and move
from doctor-centric secondary care models to continuous community-
based team support.
myCOPD
app
RightBreathe
app
Public
Health
Electronic
patient feedback
Optimum care
for COPD
patients
Medicines
Flu
vaccinations
Smoking
Cessation
Anxiety &
Depression
Social
Isolation
Exercise &
Pulmonary
Rehab
Self
management
technology
Holistic
assessment
Patient
education
Non-
pharmacological
interventions
Social & Mental
Health support
Local resources &
peer support groups
Asset Based
Community
LCO

10. Challenge – to improve care & outcomes
across whole pathway
10

11. Medicines – GMMMG guidelines
11

12. Virtual Clinics – Innovative model of care
12
Face to face meeting between primary and secondary care
(virtual because the patient isn’t there)
"An excellent service allowing
timely access to the expertise
of a consultant to discuss pre-
selected patients resulting in
a structured clinical
management plan. Provides
really positive benefits for
both clinicians and patients.”
Lesley Vernon, Practice nurse
“It has been transformational for the
practice, one of the best afternoon’s
education I have ever had.”
Peter Fink, local GP

13. MHCC Commissioned Pilot
10 Virtual Clinics:
Evaluation
13
Staff Confidence in managing
COPD increased from 4/10 to 8/10
On average 88% of
patients discussed
had changes
recommended.
60% of the changes
recommended were
Implemented six
weeks post clinic.
Of these 60% were
recommended to reduce
their ICR, this included
48% who were eligible to
stop their ICS…
£14,423 directly
attributable
drug cost saving as a
result of the clinics.
88%
60%
£14,423
60%

14. Trelegy
Trimbow
Seretide
500
Seretide
250

15. New model in practice – A GP perspective
15

16. Other innovations to
facilitate
improvements across
the patient pathway
16

17. PINGR: Quality Improvement From Primary Care Electronic Health Records with
machine learning (University of Manchester)
17
Asthma Review Toolkit Adapt Respiratory PINGR: Primary Care Dashboard
Auto-referral to Community Rapid Access Asthma Clinic

18. Rightbreathe – bespoke GMMMG pathway (Chiesi)
18

19. Patient feedback
IWantGreatCare, GSK & Aardman animations
19

20. MyCOPD?
myCOPD a complete self-management solution with
wide range of resources including inhaler technique,
delivering education and a complete online pulmonary
rehabilitation class

21. My COPD deployment in Greater Manchester
Locality Licences
Secured
Licences
Distributed
Training
Delivered
Patient
Enrolment
NHS Bolton CCG - - - -
NHS Bury CCG - - - -
NHS Heywood, Middleton & Rochdale CCG 745 67 ● ●
NHS Manchester CCG 1678 - ● -
NHS Oldham CCG 768 - ● -
NHS Salford CCG - - - -
NHS Stockport CCG 942 - ● -
NHS Tameside & Glossop CCG 924 19 ● ●
NHS Trafford CCG 601 - ● -
NHS Wigan Borough CCG 1094 - ● -

22. Interface 3rd party pharmacy-led reviews (GSK)
22

23. 23
DECIDE Education Programme©
Add value to population health through
the science of clinical decision-making
Collaborative working
• CCG : Focus on local population needs
• UoM: Educational Leadership and expertise
• HinM: Adoption at pace
Systems approach to workforce education
resulting in transformative practice
• Standardised
• Integrated
• Evidence-based
DECIDE-Dermatology: exemplar for cancer
and chronic disease (pilot)
DECIDE- Respiratory: COPD and Asthma
Pedagogy:
To target clinical
decision making
Interprofessional
Learning:
to target change
in practice
Policy:
To improve
application in
practice
Programme Director: Dr. Mini Singh
minal.singh@manchester.ac.uk

24. Asthma
24
180,000 registered
across GM
GM has higher than
national average
admission
30% fail to
attend annual
asthma review

25. Innovation in each locality
25
• Case finding and
increasing prevalence
• Whole system change
using QI methodology
(focus on high service
users)
• CCG commissioned
pharmacy reviews
• PINGR roll-out
• Community Pharmacy
Severe Asthma Digital
Platform
MyCOPD
MyCOPD
• Dedicated CCG led
Respiratory programme
• Interface reviews
• MyCOPD
• GP education
• Asthma GSK project
• New model of commissioning
integrated care
• Virtual clinic roll-out
• MyCOPD
• Interface reviews
WIGAN
BOLTON BURY
ROCHDALE
OLDHAM
TAMESIDE
STOCKPORT
TRAFFORD
SALFORD
MANCHESTER
• Citywide Respiratory Steering Group
• Embedded virtual clinics
• MyCOPD
• Interface reviews
• Asthma AZ project
• Severe asthma digital platformMyCOPD

26. Making it happen
Health Innovation Manchester
has a lead role to implement
the programme across Greater
Manchester, working in
collaboration with health,
social care and industry
partners.