Evidence into PracticeNigel Beasley

co-Chair

East Midlands Clinical Senate

N03 Merseyside and CheshireN08 North TrentN11 Pan BirminghamN36 North England

N25 South West LondonN27 DorsetN30 Thames ValleyN32 Surrey, W. Sussex, HampshireN34 Kent and MedwayN37 AngliaN38 Essex

14 month Crude Mortality

Lowest Highest

Total 12.1% 28.9%

Larynx 4.0% 38.5%

Oral Cavity 10.0% 36.4%

Oropharynx 7.5% 31.2%

DAHNO 6th Report 2011

• ‘the existence of persistent unwarranted variations in health care directly impacts on equity of access to services, the health outcomes of populations and efficient use of resources’

• ‘when there is strong evidence and a professional consensus that an intervention is effective, there tends to be little or no variation in clinical practice, but for interventions with a weak evidence base and professional uncertainly there is wide variation’

• ‘this does not means that individual practitioners are uncertain, it’s just that each makes different decision based on their experience, knowledge and interpretation of the evidence for effectiveness’

Outcome

Number

Gawande 2004

Education

Experience

CultureCulture

Experience

Education

Culture

• strong leadership

• ownership of ideas by the frontline

• freedom from external constraints

• working together across professional boundaries

Influencing

• identify a need

• bold vision

• identify key stakeholders

• project management/ communications support

• product

• surf the changing landscape

Audit Commission • NHS could save up to £500 million a year by carrying out fewer ineffective or inefficient treatments

• ‘Croydon List’ 34 low priority procedures - carpal tunnel surgery, cataract surgery, hip and knee revisions, hernia repair, varicose veins, grommets and tonsillectomy.

FSSA

• ‘lists of surgical procedures and interventions, deemed of low clinical effectiveness or of “lower value”, are being used by PCTs to limit access to certain surgical procedures’

• ‘the evidence for these lists is very poor and it is therefore inappropriate for them to be used to determine patient care without the involvement of the Specialty Associations.’

Commissioning Guidance•Define high value care

•primary care, community specialist care, secondary care

•criteria for referral and intervention

•Measure high value care•variation

•quality dashboard – process and outcome measures

•Procedures Explorer

•Lever change•audit and peer review measures

•CQUINS, Quality Schedule of Contract

Does it work?

• ‘NHS England today has welcomed the findings of an independent audit that shows 20 per cent more patients are now surviving severe trauma since the introduction of Major Trauma Networks in 2010’

What’s next?