Joint Working WorkshopThe “7 Step framework”Sharing best practiceIdentifying opportunities using real world dataKevin Blakemore, National Partnership Manager| ABPIHelen Wheeler, National Project Manager | SanofiHassan Chaudhury, Director of Health Intelligence | Health iQ
Our common goalWin:Win:Win:Win:WinPublicNHSAcademiaVoluntarySectorIndustrySocialCare
Promotion JointWorkingMEGS SponsorshipFor patient benefitYes Yes Yes YesNHS/Pharma company pool resourcesX Yes X XPharma company investmentYes Yes Yes YesNHS investmentX Yes X ODetailed agreement in placeX Yes X XShared commitment to successfuldeliveryX Yes Yes YesDetails of the agreement are madepublicX Yes O XProspective ROI Yes Yes X XOutcomes must be measuredX Yes O X
The Charles Town Project-Having the confidence to sharegives us confidence to learnHelen Wheeler, National Project Manager | Sanofi
Original Proposal•Aim was to form a collaborative group to undertake a programme ofactivities developed to address the health issues around Diabetes•To be known collectively as the “NHS Charles Town and IndustryMaximising Resources and Outcomes in Diabetes (Concord )”projectGoals•To ensure delivery of high quality diabetes care•To reduce diabetes health inequalities•Improve outcomes for all patients with diabetes in Charles Town regardlessof where they live.
Objectives of the Project1) To reduce the rate / number of avoidable admissions to hospital for patients with diabetesand diabetes related illness.2) To reduce the rate of inappropriate / avoidable utilisation of emergency services for peoplewith diabetes related illnesses.3) To develop and implement a coherent care planning approach to the management ofpeople with diabetes across primary, secondary and community services, which ensuresthat all patients have the opportunity to be actively involved in decisions about how theirdiabetes is managed.4) To work in partnership with all stakeholders including the pharmaceutical industry, in aninnovative and inclusive way throughout the project to achieve outcomes which benefitpatients with diabetes in Charles Town5) To ensure that all activities are developed and implemented in a way which improves thequality, efficiency and cost effectiveness of care in line with national QIPP objectives.
Primary CareClinician/Secondary CareClinicianPrimary CareNurse(with diabetesexpertise)CommunityPharmacy/PBCclustermanagers andclinical leadsCharles Town“City Health”(provider arm)/NHS CharlesTown HealthpromotionNHS Charles TownPublic Health/ NHSCharles Town ClinicalAudit/ NHS CharlesTown CommissioningDirectoratePharmaceuticalIndustry(one seat perorganisation)NHS CharlesTown PrimaryCare Contracting/NHS CharlesTown MedicinesManagement+ 8 industry partnersPatientRepresentativeDeveloped and managed in partnership with the ABPI Outreach Project who formed a group ofinterested member companies to act as equal stakeholders throughout.PCT-led project managed by a multi-professional multi-agency steering group consisting of alead from each of the following stakeholder groups:Project Methodology
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 theProject sponsors through the budget.
Different stakeholders theoretically agreed with the project aims and rationaleEquity of industry and NHSEndorsement of the Project from a high level (Chief Executive)Collaborative concept was goodExcellent launch - with motivational and national figures in supportInnovation project based upon a well established and successful project that the ProjectManager had led previouslyIn theory should have just replicated the last CHD projectPM was a third party and theoretically objective and skilledWhat worked well
Became a duelbetween commissioninglead/clinical leads andproject leadScepticism betweenNHS and industry hadnot left the roomIndustry was diluted -too many partnersSkill set in the projectteam not utilisedIndustry had muchof the data thatwas neededLevel of investment didnot = level of voiceProject lead became afacilitator betweenIndustry & NHS - shouldhave been left behindonce partnershipagreedPoor dynamicsToo controlled andinhibited freedom ofspeechDeclaration of interestto other industry outsideof the groupDid the Project teamfully understand thetherapy area?No clear timelinesWhat did not go so well
What went wrong: keyCommunicationbetweenStakeholdersNo real Equity ofVoice
OutcomesQuestions 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
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 – innovationtrust need to be our futurehonesty– 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 thisthrough”?if the answer is yes“well let‟s just get on with it”
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 projectmanage• 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 keepsraging
Ensure a mechanism for genuine inputUse a more effective channel of communication to the LIGImprove the equity of voice - but perhaps less voices??Have clear terms of referencesBetter governanceMake 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 dominatedIdentify and utilise what you already have before buying moreTrust - do not move forward without thisHow would we do this differently?
Group Work1. How could some of these issues have been avoided? Refer to hand-out2. 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 & ExpertiseTrustEthicsProject managementTransparencyOpennessRespectEffectivenessSupport
Identifying Joint WorkingOpportunities-7dUsing real world dataHassan Chaudhury, Director of Health Intelligence | Health iQ
CCG DataQuick 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 emergencyadmissions.– 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)
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 andfor associated improvements in health outcomes and reducing inequalities.2.The quality premium paid to CCGs in 2014/15 – to reflect the quality of thehealth services commissioned by them in 2013/14 – will be based on:four national measures and three local measures.
What is the Quality Premium?3. The four national measures, all of which are based on measures in the NHSOutcomes Framework, are:1) reducing potential years of lives lost through amenable mortality (12.5 per cent ofquality premium): the overarching objective for Domain 1 of the NHS OutcomesFramework;2) reducing avoidable emergency admissions (25 per cent of quality premium): acomposite measure drawn from four measures in Domains 2 and 3 of the NHSOutcomes Framework;3) ensuring roll-out of the Friends and Family Test and improving patient experienceof hospital services (12.5 per cent of quality premium), based on one of theoverarching objectives for Domain 4 of the NHS Outcomes Framework4) 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.
What is the Quality Premium?4. The three local measures should be based on local priorities such as thoseidentified in joint health and wellbeing strategies.These will be agreed by individual CCGs with their Health and Wellbeing Boardsand 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
What is the Quality Premium?It was decided that the three local measures would be selected to also help achievethe four national measures. The most significant of the national measures is onemergency 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 localresidents exceeded £90 million.
Group WorkLook at the following data on emergency admissions and decide: whatdoes the data demonstrate?Can you use this information to select areas for your local measure or isfurther information required?If so, which areas would you want to focus on and what you would want toachieve?15 Minutes
Local MeasuresThe 3 areas they chose were CHD, COPD and Diabetes.ACSC emergency admissions in the CCG now make up 14.1% of all emergencyhospital 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 completedcardiac rehabilitation.2. Increasing the number of people with COPD referred to a pulmonaryrehabilitation programme.3. Increasing the number of people with diabetes diagnosed less than a yearbeing referred to structured education.
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, andmulti-skilled practitioners: all dedicated to improving the quality of care and providingpeople 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
Closing Remarks7dOutcomes and FeedbackKaren Thomas, Regional Partnership Manager London | ABPI