Improving neurology services: A user guide
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The document discusses improving neurology services in England. It proposes reorganizing care by establishing multispecialty neurology providers, reorganizing acute neurology care, and collaboratively commissioning services. The goals are to prevent unnecessary admissions, improve quality of care, reduce costs, and modernize scheduled care. Key approaches include establishing neurology networks, standardized care pathways, and using data to drive quality improvement and reduce unwarranted variation across regions.
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Improving neurology services: A user guide
- 1. www.england.nhs.uk Improving neurology services a user guide DEBateman NCD Neurology 8 Nov 2015
- 2. www.england.nhs.uk • Major transformation of NHS • NHSE formation • Purchaser provider split • Radical new approach • Quality & outcomes framework 2 Health & social care act 2012
- 5. www.england.nhs.uk • Domain 1 preventing premature death • Improving acute services treatment • Preventing recurrence after an acute event 6 Measurement
- 6. www.england.nhs.uk • Generic approach with House of Care • Good primary care • Integration of care particularly with social care • Integration of physical & mental health 7 Domain 2 Enhancing quality of life for people with LTC
- 7. www.england.nhs.uk • Emergency admissions for acute conditions not usually requiring hospital admission • Keeping people out of hospital • Integration of primary & secondary care • High quality & efficient care for people in hospital • Coordinated care & support for people discharged from hospital 8 Domain 3 Helping people recover from episodes of acute ill health
- 8. www.england.nhs.uk 9 CCG Outcomes framework No neurology ones!
- 9. www.england.nhs.uk • Improving outcomes from planned treatments • Average health gain as assessed by patients for elective procedures a) hip replacement b) knee replacement c) groin hernia d) varicose veins • Preventing lower respiratory tract infections in children from becoming serious • Emergency admissions for children with lower respiratory tract infections (NHS OF 3.2) • Improving recovery from injuries and trauma • No CCG measure at present • Improving recovery from stroke • People who have had a stroke who • are admitted to an acute stroke unit within four hours of arrival to hospital • receive thrombolysis following an acute stroke • are discharged from hospital with a joint health and social care plan • receive a follow-up assessment between 4-8 months after initial admission • spend 90% or more of their stay on an acute stroke unit • Improving recovery from mental health conditions
- 10. www.england.nhs.uk • Care that supports you to keep healthy and spot any problems at an early stage • Care and treatment that is organised around you as a person • Care that ensures you feel in control of managing your own condition(s) • Care that gives you the best possible treatment in the most appropriate setting, and fully supports you to recover • Care that ensures you will always be treated with compassion, dignity and respect • Care that ensures your safety is everyone’s paramount concern and that staff are open and honest with you if things do go wrong • Care that reflects your preferences and where the feedback you provide is acted upon
- 11. www.england.nhs.uk Commissioning 12 • Specialised • CCG • Collaborative
- 12. www.england.nhs.uk • Epilepsy surgery assessment • Surgery for movement disorders • Diagnosis of rare neuromuscular disorders • Neurogenetics 13 Specialised commissioning Neurology
- 13. www.england.nhs.uk • THE REMAINDER! • All MS services including DMT • Collaborative part of the change • All GP referrals April 2015 • IP work local identification 14 CCG
- 14. www.england.nhs.uk 5YRFV 15 These Mult-ispecialty Community Providers (MCPs) would become the focal point for a far wider range of care needed by their registered patients. • As larger group practices they could in future begin employing consultants or take them on as partners, bringing in senior nurses, consultant physicians, geriatricians, paediatricians and psychiatrists NEUROLOGISTS to work alongside community nurses, specialist nurses, therapists, pharmacists, psychologists, social workers, and other staff. • These practices would shift the majority of outpatient consultations and ambulatory care out of hospital settings. • They could take over the running of local community hospitals which could substantially expand their diagnostic services as well as other services such as dialysis and chemotherapy/DMT for MS
- 15. www.england.nhs.uk Neurology multi-speciality clinic 16 • General OP clinics • Long term conditions clinics • PD MS MND NMD & Epilepsy • AHPs, specialist nurses, GPwSI, psychology, social care,neurologist • Headache clinics • GPwSI, specialist nurse, psychology, pharmacy • DMT for MS
- 18. www.england.nhs.uk Acute neurology admissions 19 • 191/100,000 for existing LTC • 6.5% under neurology • 30-70% change diagnosis • 80% change management • 500k savings average DGH • Why aren't we doing this?!
- 19. www.england.nhs.uk • Large DGHs • Acute neurology centres with acute stroke • Joint rota • Urgent clinics • TIA clinics • Shared ward base & staff • Shared rehabilitation 20 7 day working
- 21. www.england.nhs.uk Summary 22 • Multi speciality neurology provider • Re-organise acute care • Collaborative commissioning • Value better care for less money
- 22. www.england.nhs.uk • Prevention • Manage LTC well to prevent unnecessary admissions • & improve quality of care • Re-organise acute neurology care • reduced LOS • fewer admissions with HOT clinics • fewer investigations • earlier diagnosis • Modernise scheduled care to improve access 23 Value for neurology services better services at less cost
- 23. www.england.nhs.uk • CCG commissioning • Clinical networks • Care pathways • Value driven care 24 Levers & incentives
- 24. www.england.nhs.uk • Right place, time, way • Variation as a lever for improvement • Best use of resources • Missed opportunities • How do we know if MS SERVICES are better in Slough than Sunderland? 25 Right care
- 29. www.england.nhs.uk • Importance of care pathways • Networked care • Single contact & point of access 30 Organisation of care
- 30. www.england.nhs.uk • Patients & charity & in charge • Organised around patients not doctors or centres • Community & DGH • DESCRIBE CARE PATHWAY • Comprehensive service • diagnosis, DMT & 2 progressive • standards & milestones 31 MS services
- 31. www.england.nhs.uk • How many patients? • Time to diagnosis • Time to treatment • % of total on DMT • % of R&R on DMT • Complication rate 32 250-500k population
- 32. www.england.nhs.uk • MS specialist neurologist • MS nurse • Access to safe infusion & prescribing • E.g. Chemotherapy day unit or equivalent • Monitoring process in place • Access to neuroradiology reporting when required • Part of a wider clinical network • Part of a comprehensive service • Audit of service 33 Criteria for DMT provision
- 33. www.england.nhs.uk • Diagnosis • Information & support • Coordination of care • MS symptom management & rehabilitation • Relapse treatment • Quality standards Jan 2016 34 Nice guidance
- 34. www.england.nhs.uk Examples of good practice MS trust awards 35 • Multidisciplinary teams • GPwSI with integrated social work • Adult ability team • Pathway redesign • Local OP rehabilitation service • Better information • Evidence into practice
- 35. www.england.nhs.uk NHSE community neurology project 36 The project’s over-arching objective is to establish a collaborative that brings together key organisations that together will stimulate the delivery of person centred coordinated care for people with neurological conditions by encouraging the adoption of community based care models. The focus of this project is post-diagnostic care and will not address pathways to first diagnosis. The collaborative will principally aim to address needs that cut across many neurological disorders. This project is divided into three phases Phase 1: Develop a commissioning brief and toolkit Phase 2: Pilot the new framework and care models Phase 3: Implement care models into practice
- 36. www.england.nhs.uk RCGP care & support planning 37 • RCGP initiative for proactive collaborative care • Complex care conditions • Care planning • Self care • Work with third sector, social care • Sue Ryder RCGP clinical priorities group
- 37. www.england.nhs.uk • CN & NIN • CCG commissioning • 5YRFV • Levers & incentives • Examples of good practice • Dedicated charities & clinicians 38 Summary
Editor's Notes
- Ensures common goal Enshrined in legislation Primary focus of commissioning
- Threat of acute neurology general physician