Establishing a Managed Care Network for Hepatitis C

Justin Schofield

Hepatitis C MCN ManagerNHS Greater Glasgow & Clyde

Phase II Action Plan Evidence Strategic direction Investment Cross-cutting priorities &

actions

Hepatitis C MCN Co-ordinated approach to

service development New ways of working Improve service to patients

Health Boards & partners Where to start? Who to engage with? How to manage process?

Aim:

Provide overview of the process for establishing a hepatitis C MCN

Content: MCN core principles

Management arrangements

Identify stakeholders

Map patient journeys

Annual work plan

Service standards

Quality assurance

Risks & potential benefits

Definition

A Managed Care Network is: A linked group of health

professionals & organisations,

working in a co-ordinated manner,

unconstrained by existing professional andorganisational boundaries,

to ensure equitable provision of high quality, clinically effective services.

Scottish Executive MEL(1999)10

http://www.mcn.scot.nhs.uk/pdf/mel199910.pdf

1. Management arrangements Lead Clinician Network Manager

2. Structure Patient pathway

3. Annual work plan Activities Outputs Benefits to patients Annual report

4. Evidence base SIGN Clinical audit & research

findings National & local evidence

of need

5. Membership Multi-disciplinary & multi-

professional

6. Patients & vol. sector Supported to enable

meaningful participation

7. Quality Assurance MCN accreditation Clinical governance, audit, risk

management, patient safety

8. Education & training Continuous professional

development Internal & external to MCN

9. Value for money Evidence that this has been

explored

http://www.nhshealthquality.org/nhsqis/files/HDL2007_21.pdf

1: Core principles

National Hepatitis C Executive Leads Group

(in existence)

National Hepatitis C Executive Leads Group

(in existence)

National Hepatitis C MCN Clinical Leads’ Group

(in development)

National Hepatitis C MCN Clinical Leads’ Group

(in development)

National forums Lead Clinician “… overall responsibility for the

functioning of the Network” HDL(2007)21

Reflect role in Job Plan

MCN Manager / Co-ordinator Support Lead Clinician Project management Effective working relationships:

▪ Within MCN▪ Upwards to Health Board▪ Across external organisations

Hep C Executive Lead Responsible for implementation

of Action Plani. Preventionii. Testing, treatment, care & supportiii. Co-ordinationiv. Training, education & awareness raising

Budget-holder Strategic overview

• Share information, learning, resources & best practice

• Avoid duplication of effort

• Agree national standards

• National co-ordination & performance monitoring

• Communication with HPS & Government

2: Management arrangements

Care & Support Care & Support

Mental Health

Vol. Sector

Primary Care

Social Care

Drug Services

Prison

Specialist CareSpecialist Care

Hepatology

Infectious Diseases• Ultrasound • Dietetics• Psychology• Psychiatry• Laboratory• Pharmacy• Service Mgrs

Gastroenterology

Testing & ReferralTesting & ReferralPrimary

CarePrison

Inpatients GUM

Drug Services

Maternity Services

Health BoardHealth Board

Finance BBV Prevention

CHPs Other MCNs

Health Improvement

Training

PublicHealth

Public / Patient Involvement

Planning

3: Identify stakeholders

Stakeholders Strategic or operational? Internal or external to MCN? Actively involved or kept informed?

Patient Involvement Orgs. that advocate on behalf of people

living with & at risk of HCV Directly with patients & clients

Stakeholder analysis informs: MCN structure & membership Communication strategy

Identify Key service providers Available resources Patient & information flows Barriers along journey Service pressures Gaps = opportunities for

development

Available evidence Phase II Action Plan Surveillance data (HPS) Clinical database People with HCV Service providers knowledge

Agree priorities Inform annual work plan Proposed developments Associated investment

Care & Support Care & Support

Mental Health

Vol. Sector

Primary Care

Social Care

Drug Services

Prison

Specialist CareSpecialist Care

Hepatology

Infectious Diseases• Ultrasound • Dietetics• Psychology• Psychiatry• Laboratory• Pharmacy• Service Mgrs

Gastroenterology

Testing & ReferralTesting & Referral

Prison

Inpatients GUM

Drug Services

Maternity Services P

eop

le &

info

rmatio

nP

eop

le &

info

rmatio

n

Primary Care

4: Map patient journeys

MCN DEVELOPMENT SERVICE DEVELOPMENTS Communications

Web site Communication with

stakeholder groups Annual report

Membership & Structure Bring key stakeholders

into process Subgroups e.g.

▪ Prison liaison▪ Outreach testing & referral▪ Public & patient involvement▪ Uni-professional groupings▪ Clinical audit

Quality Assurance MCN accreditation Treatment protocol Clinical audit

Priorities informed by National Action Plan Local mapping

Define activities, outputs,& benefits to patients

Develop infrastructure Clinical staff resources Outpatient clinic space & locations Outreach staff & settings Agreement with partner agencies

Pilot / launch developments

Monitoring arrangements Activities Outputs Outcomes User satisfaction

5: Annual workplan

Used to asses MCN performance Sound evidence base, Clinical & care issues, Relate to the objectives

of the MCN, Clear and measurable, Follow the patient pathway, Consistent with those for other

hepatitis C MCNs across Scotland.

National standard for hepatitis C services

Phase II Action Plan – Action 2 To be developed by QIS &

national MCN Leads Network Due 2010

Phase II Action Plan accompanied by draft guidelines for hepatitis C MCNs

Inform service standards National & local

1. Accountability and organisation

2. Policies and procedures

3. Testing

4. Specialist referral

5. Management and treatment

6. Care and support

7. Collaboration and partnership working

8. Patient information and awareness-raising

9. Education and training

10. Monitoring, evaluation and audit

6: Service standards

MCN Accreditation NHS Board accredits local

MCNs Existing process & support

MCN must demonstrate:1. Plan to implement core

principles

2. Service standards developed

3. Monitor implementation of core principles & standards

4. Reporting arrangements in place

5. Process for implementing recommendations

QIS Quality Assurance toolkit*

Overview Guidance Templates

* Toolkit provided with this presentation

7: Quality assurance

MCN Accreditation Timetable: Yrs 1 & 2

Year 1: 2008

• Secure stakeholder involvement

• Secure public / patient involvement

• NHS Board endorsement

• Define MCN structure

• Define patient pathway

• Agree priorities & key improvement measures

• Define the MCN communication strategy

• Assess progress against QIS Quality Assurance model

• Report progress to Board

Year 2: 2009

• Define work programme

• Refine priorities

• Establish education programme

• Establish audit and research programme

• Formal launch

• Assess progress against QIS Quality Assurance model

• Report progress to Board

7: Quality assurance

RISKS BENEFITS

Lack of corporate buy-in

Threat to clinical autonomy

Resistance to change

Range of organisations with own pressures & priorities

Bureaucracy

Inertia

Organisational capture by dominant partner

Tokenistic user involvement

Integrated patient care across professional & organisational boundaries

Equitable service provision

Reduce duplication of effort& resources

Best use of scarce resources

Innovation

Patient-centred services

Development opportunities for staff

Risks and benefits

Key messages