The slides from 14 January 2015 webinar with #7dayservices early adopter site County Durham and Darlington NHS Foundation Trust

1. Seven Day Services Transformational
Improvement Programme:
Community of Practice
14th January 2015, 11:30-13:00
Improving health outcomes across England by providing improvement and change expertise
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2. Seven Day Services Improvement Programme in partnership with NHS England
Agenda
National overview and update
• Jo James Programme Delivery Lead, Seven Day Services Improvement Programme, NHSIQ
Overview of CD&D 7 day service preparation
• Mike Brierley, Head of Customer Programme Manager, North of England Commissioning
Support Unit
Developing improved multi-disciplinary working on hospital wards
• Ian Briggs, Associate Director for Business Development, County Durham and Darlington NHS
FT
Taking an integrated locality approach to 7 day delivery
• Dr Andrea Jones, Chair, NHS Darlington CCG
• Jane Haywood, Clinical Director, Adult and Integrated Services, County Durham and
Darlington NHS FT
Information governance and data sharing
• Lisa Wilson, Head of Information Governance and IT Security, Health Informatics, County
Durham and Darlington NHS FT
• Eileen Carbro, Commissioning Manager, Service Planning and Reform, North of England
Commissioning Support Unit
Information governance - National perspective
• Rhuari Pike, Locality Delivery Manager, Seven Day Services Improvement Programme , NHSIQ

3. Seven Day Services Improvement Programme in partnership with NHS England
Jo James
Programme
Delivery Lead
Seven Day Services
Improvement Programme
Seven Day Services Improvement Programme in partnership with NHS England

4. Seven Day Services Improvement Programme in partnership with NHS England
Time to Change
• Five day service model not
meeting patient needs or
expectations.
• Increasing evidence of poor
outcomes for patients admitted
at weekends
- mortality rates
- re-admission rates
- length of stay
- patient experience
“This change
will be
difficult - but
it is the right
thing to do.”
Sir Bruce Keogh,
National Medical Director

5. Seven Day Services Improvement Programme in partnership with NHS England
Mortality rates
• Significantly greater risk of dying (up to 16%)
for weekend admissions
• Multi-factorial, likely to be result of:
 Variable staffing levels
 Absence of senior decision-makers /
consultant level skill and experience
 Lack of specialist services (eg diagnostics)
 Lack of specialist community and primary care
services to support patients to die at home

6. Seven Day Services Improvement Programme in partnership with NHS England
Other outcomes
Length of stay
• Factors contributing to unnecessarily longer stays
more pronounced at weekends
• Waiting for senior assessment equates to longer LoS
Readmission rates
• Working between different parts of system more
difficult, impacting on readmissions
Patient Experience
• Lack of senior decision makers hinders
communication

7. Seven Day Services Improvement Programme in partnership with NHS England
The journey so far…..
• Everyone Counts: Planning for Patients 2013/14
- “The NHS will move towards routine services
being available seven days a week.”
• Seven Day Services Forum established - urgent
and emergency services, supporting diagnostics.
• Forum’s recommendations approved by NHS
England – including adoption of 10 clinical
standards.

8. Seven Day Services Improvement Programme in partnership with NHS England
The journey so far… (cont’d)
• Forum scope widened -
consideration of a fully
integrated seven day service.
• Five Year Forward View: key
part of system transformation
“…we will develop a framework
for how seven day services can
be implemented affordably and
sustainably…”

9. Seven Day Services Improvement Programme in partnership with NHS England
The clinical standards
Patient
Experience
Time to first
consultant
review
MDT
Review
Shift
Handovers
Transfer to
community
and Primary
and social care
Mental
Health
Quality
Improvement Diagnostics
On-going
review
Intervention
/Key services
Patient
Experience
Time to first
consultant
review
MDT
Review
Shift
Handovers
Transfer to
community
and Primary
and social care
Mental
Health
Quality
Improvement Diagnostics
On-going
review
Intervention
/Key services

10. Seven Day Services Improvement Programme in partnership with NHS England
The timescale
• Local contracts to include action plan for
delivering the clinical standards.
Year one
2014/15
• 5 out of the 10 standards to be
implemented by end of March 2016.
Year two
2015/16
• Full implementation of all 10 clinical
standards by March 2017
Year
three
2016/17

11. Seven Day Services Improvement Programme in partnership with NHS England
Seven Day Services Partners
NHS England
Health Education England

12. Seven Day Services Improvement Programme in partnership with NHS England
NHS Improving Quality’s role
• Spread change, foster collaboration and build momentum
• Help with the ‘how to’:
- spreading learning and knowledge
- advice and support
- resources to support delivery
- connecting people
• Build capacity and capability - service improvement.
• Champion patient and public involvement.
• Evaluation and measurement of impact.
• Shape future policy - identify barriers/challenges.

13. Seven Day Services Improvement Programme in partnership with NHS England
Seven Day Services
Improvement Programme
1. Diagnostics - spreading evidence-based
models
2. Engaging all healthcare communities in
moving towards services that meet the
clinical standards and identifying the top
interventions
3. Designing new models of seven day services

14. Seven Day Services Improvement Programme in partnership with NHS England
Early Adopters

15. Seven Day Services Improvement Programme in partnership with NHS England
Challenges
“There are
numerous plans
and strategies in
place but little
positive action and
achievement.”
“Stakeholders are
finding it difficult to
‘see outside their
own front door’ due
to operational
pressures and cost
reduction.”
“Everyone thinks that the CCGs should be
driving the agenda…but in some areas
leaders are questioning whether they have
the courage to be radical.”
“We were slow to realise
that it not about additional
funding or simply adding to
our workforce, we were not
thinking laterally across the
whole health economy.”
“Patients want 7 day
services but react
when we need to
relocate services to
offer a 7 day service."
“Competition between
Trusts and lack of trust
between us is one hurdle.”

16. Seven Day Services Improvement Programme in partnership with NHS England
How we can help
• Help develop system-wide approach, including
coproduction of local events.
• Knowledge and learning sharing – connecting
to others.
• Quality improvement and service redesign
advice and support.
• Support with baseline, gap analysis and
planning.

17. Seven Day Services Improvement Programme in partnership with NHS England
Self-assessment tool
• Developed to help plan for seven day services and
national clinical standards.
• Provides baseline against standards, helps identify
gaps and local needs.
• Considers patient involvement, barriers and drivers,
and potential benefits.
• Use to stimulate discussion across local health
community.
• Register at www.7daysat.nhs.uk

18. Seven Day Services Improvement Programme in partnership with NHS England
Contact us
 7DayServices@NHSIQ.nhs.uk
@NHSIQ #7dayservices

19. 7 Day Services – Beyond
Assessment
County Durham and
Darlington

20. County Durham and Darlington
Health and Social Care 7 Day Services Overview
County Durham and
Darlington
“Beyond Assessment”
Mike Brierley
Head of Customer Programme Manager
North of England Commissioning Support Unit (NECS)

21. “Beyond Assessment”
County Durham and
Darlington
County Durham & Darlington Profile
• Population base served:
– 610,000 approximately
• 3 Clinical Commissioning Groups
– North Durham, DDES &Darlington
– 82 GP practices
• County Durham and Darlington NHS
Foundation Trust – integrated acute /
community health care provider
– 2 Acute hospitals
– Access to six community hospitals
• Tees, Esk and Wear Valley NHS
Foundation Trust
– Provides inpatient and
community services
• Two local authorities
– Darlington Borough Council
– Durham County Council
• North East Ambulance Service (NEAS)

22. “Beyond Assessment”
County Durham and
Darlington
Approach to 7 Day Services
• Whole economy integrated approach
• Health
• Social Care
• Third Sector
• Patient groups
• Service Transformation
• Integrated governance and planning across all partners
• Align with locality strategies such as ‘Better Care Fund’.
• Programme Methodology for delivery with three priority areas
• Frail elderly
• Urgent Care
• Diagnostics

23. “Beyond Assessment”
County Durham and
Darlington
Programme Methodology
Establish
The
programme
Mobilise Breakthrough
System re-design
Review
Evaluate
& Plan
• Agree key 7 day
principles
• Define point B &
understand point
A
• 7 day working
gap analysis &
change agenda
• Programme Plan
• Business case
• Create steering
group, change
support team &
key pathway
teams
• Preparing key
clinicians &
mangers to lead
change
• Establish the
case for
change
• Stakeholder
analysis &
comms
strategy
• Creating a
shared 7DS
vision
• External
visits
benchmark
• Staff input
into 7DS
change
agenda
• Simple wins
3 Key pathfinder
areas
• Frail Elderly
• Diagnostics
• Urgent care
• Cascade vision
into pathfinder
areas
• Early Wins
• Re-designing work
process and systems
• Social systems design
• Service configuration
• Governance &
Infrastructure design
• Define capability
needs
• Performance mgt
design
• HRWorkforce
systems design
* Red Text – Areas
of Progress
• Review &
evaluate
pathfinders
• Finalise 7 day
working
system &
design
• Consultation
• Develop
phased full
roll-out
business case
& Plan

24. “Beyond Assessment”
County Durham and
Darlington
Areas of Progress
• County Durham and Darlington Foundation Trust acute baseline
assessment
• Multi-disciplinary team development:
• Acute based
• Community based
• Analysis of key barriers to change
• Integrated planning documentation including vision, principles
and service blueprints
• Information sharing Agreements (ISA)
• Template and populated ISAs
• Case study on information sharing

25. Developing improved multi-disciplinary working
on hospital wards
County Durham and
Darlington
“Beyond Assessment”
Kelly Bentham
Head of Business and Performance: Acute and Long Term Conditions
County Durham and Darlington NHS Foundation Trust
Ian Briggs
Associate Director Business Development
County Durham and Darlington NHS Foundation Trust

26. “Beyond Assessment”
County Durham and
Darlington
Standard 3 - Multi-disciplinary
Team (MDT) review
“All emergency inpatients must be assessed for complex or on-going needs within 14
hours by a multi-professional team, overseen by a competent decision-maker, unless
deemed unnecessary by the responsible consultant. An integrated management plan
with estimated discharge date and physiological and functional criteria for discharge
must be in place along with completed medicines reconciliation within 24 hours.”
Supporting information:
• The MDT will vary by specialty but as a minimum will include Nursing,
Medicine, Pharmacy, Physiotherapy and for medical patients, Occupational
Therapy.
• Other professionals that may be required include but are not limited to:
dieticians, podiatrists, speech and language therapy and psychologists and
consultants in other specialist areas such as geriatrics.
• Reviews should be informed by patients existing primary and community
• Appropriate staff must be available for the treatment/management plan to
be carried out

27. “Beyond Assessment”
County Durham and
Darlington
PERFORM is a people-focussed
management system that changes behaviours
A management system that drives
new behaviours to achieve a step change in
operational effectiveness and efficiency.
KPIs, performance boards,
performance reviews,
competitions, recognition,
vision, coaching, training
Director visibility and presence,
Team leader driving team
performance, Team member
control and responsibility
Understanding the quality of
the work that is done, getting
things right first time to reduce
the number of errors
Managing capacity and
removing the unnecessary parts
of the process to reduce the
time taken to respond to clients
and improve service levels
without compromising quality
PERFORM

28. “Beyond Assessment”
County Durham and
Darlington
PERFORM Seeks To Challenge
Traditional Ways Of Working
Fire fighting
“I’m working long hours fixing the latest issues...it never seems to stop”
I am frustrated with social service
There is a high variation in clinical performance including discharge
process and consumables used
Management by email
“I received 200 emails yesterday, how do you expect me to meet with my
team”
The blame game
“We cannot discharge patients on time because social service cannot
accommodate
“Poor communication regarding clinic scheduling, working lists and clinic
cancellations”
Sickness levels are high
The performance disconnection
“I’m not sure how I impact our department’s performance”
Active management
“I understand issues before they happen because of
increased visibility of performance and more regular review”
From a traditional way of working... ...to the PERFORM way of working
Management by walking the floor
“I have a structured day that allows me time to understand
problems and best practice in my team”
Working together
“When things go wrong we raise problems and work
together with other teams to resolve them”
Connected performance
“I know what is required of me on a day-to-day basis and
can see how it impacts my department”

29. “Beyond Assessment”
County Durham and
Darlington
MDT Team: Identifying EDD and
Management Plan for Every Patient 7
Days a Week
Ward 11’s
Board
Team track daily
discharges 7
days a week
Team identify
issues that cause
delays for
patients
Team schedule
problem solving
sessions to
understand and
resolve issues
Team celebrates
success by
highlighting what
they are doing
well
MDT daily focus
is on EDD

30. “Beyond Assessment”
County Durham and
Darlington
Perform is Aligning The Strategic
Goals To Operational Delivery
Matrons and Ward Managers
discuss ward performance daily,
number of discharges, set targets
and share best practice
Head of Nursing Services and
Business Manager discuss
weekly performance with Matrons
weekly
Divisional COO discusses weekly
divisional performance and impact
on bed capacity
Strategic level
Tactical level
Operational level
Perform alignment – people talking about the things
that they can control with the information
that they need

31. “Beyond Assessment”
County Durham and
DarlingtonChallenges
• Winter
• Time
• Reconfiguration
• Strategic and operational leadership
• Sustainability
• Celebrating success

32. “Beyond Assessment”
County Durham and
DarlingtonAchievements
7 DAY MDT
Average
Discharge
Increase by
7%
Reduction in
LOS 5% Medical
Boarders Per
Day
Reduction of
67%
AM
discharges
Increase by
13%Non acute of
patients per
week
Increase by
27%
ED Activity
Increase by
5%
Falls per
week
Reduced by
25%

33. “Beyond Assessment”
County Durham and
Darlington
What Trust Staff Are Saying About
PERFORM
“Perform has given us
daily communication
with key people such as
Physiotherapists and
Occupational therapists.
It has given us instant
feedback from these
teams.”
Ward Manager
“I was not enjoying my
job before Perform and
was thinking of leaving
– now I look forward to
coming into work
again”
OT Manager
“Multi disciplinary teams
identifying opportunities to
improve quality and
performance through
collaborate working to deliver
change and share best practice
whilst not forgetting to
celebrate achievements and
success.”
Lead Business Manager
“Engagement from all the
MDT is brilliant- decisions
are being made quickly,
efficiently and staff feel
empowered to make
decisions.”
Ward Matron
“Perform has improved the efficiency of the team as a whole, given the scope
for many members of the MDT to contribute collectively at the care of the
patients. It has also allowed us to focus on which patients can be discharged,
and the barriers to this.”
Medical Consultant
“Before Perform I was not
enjoying my job – I did
not look forward to
coming into work. Now
with improved
communication I feel I can
do my job better.
(paraphrased,
anonymous)
“I have worked at 5
other Trusts and no
where have I seen
effective working like
this – I am now looking
to stay at Durham”
Medical Registrar
“Perform has given the inpatient areas a daily
platform for multi-disciplinary working. This
model gives the teams an opportunity to focus on
actions that are needed to address areas of each
patient pathway in order that they have timely
and appropriate interventions that leads to a safe
and effective discharge.”
Head of Inpatient Services

34. “Beyond Assessment”
County Durham and
Darlington
Further 7 day Projects Which Have
Stemmed From The Implementation
Of Standard 3…
There are 4 key issues which are blocking medically fit patients from leaving the ward…
On average the information centres across the six wards are typically seeing 30 patients
per week who are now medically fit for discharge but are “blocked” in the system due to
problems which are being addressed.
Just over one
third of the
patients ready to
move on are
under the Trust’s
control
By making problems visible on information centres, the teams have highlighted 4 key areas
of focus: CHC assessments, Nursing Home discharges, Diagnostics and community
hospitals.

35. Taking an integrated locality Approach to 7 Day
Delivery
County Durham and
Darlington
“Beyond Assessment”
Dr Andrea Jones
Chair
Darlington Clinical Commissioning Group
Jane Haywood
Clinical Director Adult & Integrated Services
County Durham and Darlington NHS Foundation Trust

36. “Beyond Assessment”
County Durham and
DarlingtonWhat We Are Trying To Achieve
• Improve patient experience
• More effective care planning and packages centred on individual
needs
• Care in the community or at home where preferred option
• Increase in self-management
• Increased involvement of Voluntary Care sector
• Prevent unnecessary acute admission/re-admission
• Reduce length of stay (e.g. through ‘in-reach’)
• Reduce number of patients transferred to long term care

37. “Beyond Assessment”
County Durham and
DarlingtonStakeholders Involved
• Darlington CCG & Associated Practices
• County Durham and Darlington FT
• Darlington Borough Council
• Tees, Esk and Wear Valley FT
• Voluntary Sector
• Care Home Sector
• Healthwatch
• NEAS
• North of England Commissioning Support

38. “Beyond the Assessment”
County Durham and
Darlington
Elderly in Acute
Hospital bed
Rapid Assessment Base
(request diagnostics) 8-8 x
7 days
MDT Community
Rapid Response &
case management
GP
practices
Nursing
Homes
Long Term Condition Case
management/Care Planning/EOL
Self Management
Crises patient
Ambulance
999
Life threatening
Diagnostic
rapid access
pull
pull
By-pass
A&E

39. “Beyond Assessment”
County Durham and
DarlingtonProgress since March 2014 –
Primary Care
• Practice MDT’s take place monthly in place with attendance from
Social Workers, Community matrons and Voluntary Sector brokers
• Advanced care plans being developed for 2% of population at
highest risk of emergency admission
• Monthly meetings to discuss those who have had emergency
admission in previous month & agree how care plan/support
package needs to be amended to prevent re-occurrence
• Voluntary sector broker liaises with other VS organisations as
appropriate
• Referrals made to other teams as appropriate e.g. mental health
• Evolutionary development

40. “Beyond Assessment”
County Durham and
DarlingtonProgress since March 2014 – Care
Homes and initial feedback
• Community Matrons now working 9am – 5pm; 7 days a week
– linked to Top 10 Care Homes
• District Nurses pick up any referrals overnight
• Community Matrons attending all GP practices monthly MDT’s
• EHCP/Advanced Care Plans starting to be put in place for all
patients in care homes.
• NEAS aware of new ways of working and ring Matrons prior to
patients conveyance to hospital

41. “Beyond Assessment”
County Durham and
DarlingtonKey Benefits and Value Added

42. “Beyond Assessment”
County Durham and
Darlington
Outcomes So Far:
Emergency Admissions from Care Homes –
April to November 2014
Local
authority Location Name Apr-14
May-
14 Jun-14 Jul-14 Aug-14 Sep-14
Oct-
14
Nov-
14
Current
Total
Darlington
Darlington Manor Care
Home 6 4 6 3 4 1 24
Darlington Eastbourne Care Home 6 8 1 8 6 8 4 2 43
Darlington Eden Cottage Care Home 6 8 1 8 6 8 4 2 43
Darlington Grosvenor Park Care Home 8 7 9 8 5 9 6 52
Darlington Rydal Care Home 3 2 2 4 2 10 2 25
Darlington St Georges Hall and Lodge 4 5 6 4 7 4 2 32
Darlington The Gardens Care Home 9 5 8 8 6 7 5 2 50
Darlington The Grange 8 17 16 5 7 6 6 2 67
Darlington Ventress Hall Care Home 4 5 7 11 8 4 4 2 45
Darlington Willow Green Care Home 14 9 8 7 5 3 3 1 50
Monthly total 68 65 63 68 49 66 38 14 431

43. “Beyond Assessment”
County Durham and
DarlingtonIssues – Or Challenges And
Opportunities
• Multi organisation working
• Aligning national strategies against challenging
timelines
• Information sharing
• IM & T
• Communication

44. “Beyond Assessment”
County Durham and
DarlingtonFuture direction and next steps
• Community Rapid Assessment Service - Front of House
• Geriatrician telephone advice line 12:00 – 14:00 Monday to
Friday
• Hospital to Home
• Additional matrons/assistant practitioners to support
remaining care homes
• Identification of areas for future development/investment

45. Developing the Information Sharing Agreements
(ISAs)
County Durham and
Darlington
“Beyond Assessment”
Lisa Wilson
Head of Information Governance & Trust Data Protection Officer
County Durham and Darlington NHS Foundation Trust
Eileen Carbro
Commissioning Manager
North of England Commissioning Support (NECS)

46. “Beyond Assessment”
County Durham and
DarlingtonBarriers to sharing information?
• There shouldn’t be any.
• Ensuring we comply with the legal and regulatory
framework and various requirements (e.g. Caldicott 2
report)
• Professional/public attitudes to sharing information differ.

47. “Beyond Assessment”
County Durham and
DarlingtonOvercoming the ‘Barriers’
• It’s not ‘we can’t share’ – its ‘how can we share’
• An Information Sharing Agreement (ISA) is a document
for all parties to agree :
• Assist compliance with information rights law and
practice.
• Set’s out standards and consistency that have to be met
by all signatories.
• Ensure patient consent is achieved in process

48. “Beyond Assessment”
County Durham and
DarlingtonApproach
• North East Information Governance (IG) Managers
developed Multi Agency Information Sharing protocol –
ISA Template used is an appendix of this.
• Balance between legislation (e.g. consent) and best
interests of the patients for their healthcare
• Engagement between IG leads essential to understand
concept and agree way forward.

49. “Beyond Assessment”
County Durham and
DarlingtonWhy We Needed to Share
Information
• Identified and agreed to develop two phases of
information sharing for specific parts of project:
1. Data analysis across health and social care
organisations to inform planning (e.g. identify
patient cohorts, team roles required, capacity)
2. Sharing of relevant client information across
partner organisations to support new ways of
working and processes across partners
* Examples used are for the Darlington MDT for frail elderly

50. “Beyond Assessment”
County Durham and
DarlingtonPhase 1 – Data Analysis ISA
• Data Analysis ISA:
– Allow sharing of information to identify the cohort of patients we needed
to target for the project.
– 3003 frail elderly patients identified
• 76% were in GP practice DES (direct enhanced services)
• Care homes – 12% of DES
• Assumption 88% care home population were included in the
initial 3003 identified patients
– Data then shared across Social Services/Mental Health and Acute Trust to
determine how many of Frail Elderly cohort already known to them
– Results surprising and very beneficial; informed planning of roles/capacity
required

51. “Beyond Assessment”
County Durham and
DarlingtonPhase 1 – Data Analysis ISA
Challenges
• Question whether using NHS number for
planning/commissioning purposes met regulatory/legal
framework
– Issues with NHS number “used only for direct patient
care”
• After local and national review over several months –
NHS Number could be used if appropriate ISA was
agreed by all partners

52. “Beyond Assessment”
County Durham and
DarlingtonPhase 2 - MDT Process ISA
• Can only start ISA when processes have been agreed by
staff involved.
• ISA detailed what information will be shared, how it will
be shared, how it will be transferred, stored and securely
disposed of, also covered a range of other areas e.g.
training, incident reporting etc.
• ISA for Third sector organisations were new, challenging
and surprising.
• Full Communication between all parties crucial.

53. “Beyond Assessment”
County Durham and
DarlingtonPhases 1 and 2 - ISA lessons learnt
• Must be a single lead / facilitator
• Standards have to be met by all parties, discussions of
how these can be worked towards / met.
• Version control is a must to track different comments.
• Central point for all comments and signatories.

54. “Beyond Assessment”
County Durham and
DarlingtonFuture Challenges
• Identified a broader range of Voluntary Sector
Organisations who have not yet signed current ISA
• Lack of understanding - CCG’s for the need for this
protection (seen as red tape)
• Integrated working outside the public sector
• Shared / integrated electronic systems
• Acceptance of the learning and sharing across other
organisations - don’t reinvent the wheel

55. Seven Day Services Improvement Programme in partnership with NHS England
Information
Governance
Rhuari Pike
Locality Delivery Manager
Seven Day Services
Improvement Programme

56. Seven Day Services Improvement Programme in partnership with NHS England
National actions: Progress.
• Background: SDSIP support to CDD 7DS team.
– two way conduit for information.
• Purpose:
1. Data analysis.
2. Sharing of relevant information.
• Escalated to NHSIC/NHS England IG to clarify.
– A conference call allowed the process followed to date,
following local guidance, to be presented for clarification and
support, and for debate to allow greater understanding both
of the full extent of the issue, and the solutions
recommended.

57. Seven Day Services Improvement Programme in partnership with NHS England
• Case study being written up.
– Contains process followed, outcomes, copies of
documentation produced (inc’ Information Sharing
Agreements).
– To be shared via NHSIQ/SDSIP website.
• Escalated to NHS England (7DS Implementation Board).
• Recognition that the scale of the problem has not been
identified nationally.
– Purpose of the EA sites is to identify these issues.
• Clear national guidance to be developed about how to
overcome these problems.
• Assurance of how the NHS number can be used for
these purposes.

58. Seven Day Services Improvement Programme in partnership with NHS England
• Further learning from 7 Day Services Early Adopters
• How Healthwatch have contributed to the 7 day services agenda
• Approaches and solutions to workforce issues and how Health Education
England can support 7 Day services
• Sharing the learning of new models of care
Let us know if:
• there are other topics you are interested in
• If you have work you would like to share
www.nhsiq.nhs.uk
7DayServices@NHSIQ.nhs.uk
#7dayservices
Future Communities of Practice