1. Joint Working - Varied Success!
Amanda J Schofield
Quality Improvement Lead
Greater Manchester, Lancashire
& South Cumbria Strategic
Clinical Network & Senate
26.06.13

2. NHS | Presentation to [XXXX Company] | [Type Date]2
Overview
• A brief overview of each project
• What went well
• Barriers
• Key points for future project

3. GMCCSN Joint Working Proposals
1.Mapping the provision of Anticoagulation Services
for patients with Atrial Fibrillation (AF) across
Greater Manchester (GM) – Boehringer Ingelheim
(July 2010 – 2011)
2.The Management of Patients with Deep Vein
Thrombosis in GM – Bayer Healthcare (February
2013 - Present)
3.Door In Door Out Project – Company A &
Company B (January 2013 – Present)
3 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

4. 1. GMCCSN, GMMMG & Boehringer Ingelheim
Initiation
• Government directive on Atrial Fibrillation and
stroke prevention
• New Oral Anticoagulants – Licensed
• Commissioned by GM Association of PCT’s
• Three way partnership
• Open and Transparent
4 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

5. GMCCSN, GMMMG & Boehringer Ingelheim
Key Points
• Detailed joint working agreement
• Shared vision
• Shared project management
• Knowledge sharing
• Pooling of resources
• Outcomes were patient focused
5 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

6. GMCCSN, GMMMG & Boehringer Ingelheim
Project Aims
• Examine care pathways for patients with AF
• Understand the provision of anticoagulation services
• Achieve the best outcomes for patients in terms of clinical
efficacy and cost effectiveness
• A controlled introduction from a financial and new clinical
intervention perspective
6 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

7. GMCCSN, GMMMG & Boehringer Ingelheim
Deliverables
• GM algorithms
• Care pathway
• GRASP AF implementation
• Most effective prescribing for AF patients
7 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

8. 2. GMCCSN & Bayer Healthcare
Initiation
• GMMMG and GM commissioners agreement for GMCCSN
to look at the clinical pathway for Venous Thromboembolim
(specifically DVT)
• Extensive clinical support to evaluate the protocol and
guidance
• New oral anticoagulation therapy licensed for DVT
• New NICE guidance released in June 2012
8 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

9. GMCCSN & Bayer Healthcare
Key Points
• Detailed Joint working agreement drafted
• Shared vision
• Shared project management
• Pooling of resources
• Knowledge sharing
• Outcome patient focused
9 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

10. GMCCSN & Bayer Healthcare
Project Aims
• To improve and standardise the management of patients
with a DVT across Greater Manchester
• The development of a new protocol and pathway to manage
patients with suspected DVT within Greater Manchester
• The development of a structured, consistent and organised
approach in the management of DVT
• Improve patient outcomes
10 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

11. GMCCSN & Bayer Healthcare
Outcome
• Not a joint working project
• Unanimous decision from project steering group members
• Historical suspicion
• Bayer Healthcare invite
• Standardised protocol development continues
• Collaborative GMMMG prescribing guidance
11 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

12. 3.GMCCSN & Company A and Company B
Initiation
• Call to Balloon Time – national guidance 150 minutes
• A GM pathway flow problem had been indentified
• Project mandated by GMCCSN Cardiac Board
• Door – In – Door – Out (DIDO) steering group
• GMCCSN approached by company A to work jointly
• Advice from GMMMG to approach Company B
NHS | Presentation to [XXXX Company] | [Type Date]12

13. GMCCSN & Company A and Company B
Key Points
• Joint working agreements drafted
• Clinical engagement and agreement from the beginning
• Agreement patient outcome focused
• Individual companies input
• Pooling of resources
• NHS reconfiguration
NHS | Presentation to [XXXX Company] | [Type Date]13

14. GMCCSN & Company A and Company B
Project Aims
• Ensure that all patients receive effective yet extremely
prompt assessment and referral from their local ED to the
heart attack centre for their treatment.
• Target DIDO time of 30 minutes across GM.
14 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

15. GMCCSN & Company A and Company B
Outcome
• Not a joint working project
• GM treatment pathway - competition
• Company B supporting training and sponsorship
• Openness and transparency
• NHS reconfiguration
• Communication
• Time
15 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

16. Varied Success
• Patient focused
• Governance
• Shared benefits
• Pooled resources
• Engagement
• NHS Reconfiguration
• Communication
• A Competitive market
16 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

17. What does success look like?
• Have a clear understanding from beginning
• All cards on the table
• Detailed plans
• Communication (internal/external)
• Leadership
• Decision makers – who are they?
• Trust
• Commitment
17 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

18. Key Differences
NHS England GM Lancs & South Cumbria SCN & Senate 26/06/1318
Key differentiators
POOLING of resources by NHS/pharmaceutical company(ies)
Detailed joint working agreement
Outcomes (for patients, NHS, company(ies)) clearly articulated and measured
Details of arrangements made public

19. Contact information:
Name: Amanda Schofield
Job title: Quality Improvement Lead
Company: Greater Manchester, Lancashire and South
Cumbria SCN and Senate
Email: a.schofield1@nhs.net
Tel: 07795127368
19 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13