Lanarkshire’s Primary Care and Mental Health …...3.6 Workstream 6 – GP Digital Services 11 3.7 Workstream 7 – Pharmacists in Practice 13 3.8 Workstream 8 – Mental Health

Lanarkshire’s Primary Care and Mental Health Transformation Programme

Final evaluation report

19th November, 2018

Dr Helen Alexander

REPORT CONTENTS

Page 1 INTRODUCTION

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2 METHOD

1 3 RESULTS

1 3.1 Overview of contributions to outcome achievement

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3.2 Workstream 1 - General Practice & Community Redesign

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3.3 Workstream 2 – Urgent Care

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3.4 Workstream 3 – House of Care

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3.5 Workstream 5 – Recruitment and Retention

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3.6 Workstream 6 – GP Digital Services

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3.7 Workstream 7 – Pharmacists in Practice

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3.8 Workstream 8 – Mental Health

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4 CONCLUSIONS & RECOMMENDATIONS

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Final evaluation report on Lanarkshire’s Primary Care & Mental Health Transformation Programme 19th November, 2018

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1 INTRODUCTION It is important for us to know that any changes being made are improvements. Lanarkshire’s Primary Care and Mental Health Transformation (PCMHT) Programme was evaluated using a recognised approach called Contribution Analysis (CA) which acknowledges the difficulty establishing cause and effect in a complex system. It recognises the diversity of different influences on observed results and the interdependencies between initiatives/services, whilst allowing us to demonstrate where we have had a positive impact. The PCMHT Board agreed on 16th November 2016 that the local evaluation should use a Contribution Analysis approach and this report is the third and final story for this programme. 2 METHOD This local evaluation focused in some depth on seven of the Lanarkshire PCMHT workstreams (excluding the work around leadership). There are six distinct steps with CA, the first two of which can largely be agreed at the outset:

1. Set out the cause-effect issue to be addressed 2. Develop the postulated theory of change 3. Gather the evidence for the theory of change 4. Assemble and assess the contribution story, and challenges to it 5. Seek out additional evidence 6. Revise and strengthen the contribution story (THIS REPORT)

The PCMHT Board agreed that Step 1 was for their programme to transform primary care and mental health services. The links between inputs, activities and outcomes were made explicit in seven theories of change (Step 2), represented as logic models or outcome achievement frameworks. These were developed in collaboration with each workstream and the Improvement Support Team (IST). Those involved agreed what their main outcomes would be (and in some cases the pre-requisite processes) and what evidence would demonstrate a contribution towards their achievement. Many of the early iterations were altered as the workstreams evolved and versions of them will be useful for evaluating the Primary Care Improvement Plan.

The PCMHT programme in Lanarkshire benefited from a dedicated Improvement Support Team (IST) that facilitated the use of Quality Improvement (QI) methodology. Their collation of all the associated QI data into a measurement framework for each workstream helped to identify what would also provide evidence for the Contribution Analysis. A separate Evaluation Measurement Plan identified agreed evidence of outcome achievement for each workstream, including qualitative data gathering. Data was largely generated by those leading the individual tests of change within each workstream, but the evaluation team assisted where required. 3 RESULTS The evaluation considered each of the PCMHT workstreams as separate entities, albeit with some awareness of interdependencies/overlaps. The first table in this section illustrates the achievements across the seven workstreams evaluated, and is followed by the same information for each workstream, namely the latest version of their achievement framework and an evidence table of contributions towards outcome achievement. The tables include only those outcomes where robust evidence was available, without comment on data that was not gathered/submitted.

Helen Alexander


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3.1 Overview of contributions to outcomes achievement (for workstream detail see sections 1.2 to 1.8)

Table 1 – Evidence of contributions to achieving PCMHT workstream outcomes (pink) and any prerequisite processes (blue) General Practice & Community Redesign

Urgent Care House of Care Recruitment & Retention

GP Digital Services Pharmacists in Practice

Mental Health

Increased primary care capacity to treat patients

Greater access to appropriate healthcare professional

Increased knowledge of long-term conditions

Practice closure assessment tool developed

On-line access to book appointments

GPCPs appointed to practices and undertaking agreed activities

Decreased mental health stigma

Greater access to appropriately trained healthcare professionals

Improved response to mental ill-health

Increased ability to self-manage

Closure risk assessed for all practices

On-line access to order repeat prescriptions


Improved health literacy

Increased access to MSK Physiotherapy assessment, diagnosis & management

Fewer unnecessary paediatric hospital admissions and ambulance

transfers

Good engagement with care planning

Good understanding of GP recruitment and retention issues

Mobile working devices provided

Greater practice staff knowledge of GPCP role

Improved Community Pharmacy relationships with clients

Improved functioning i.e. occupational performance

Improved satisfaction with the Urgent Care service

More rewarding consultations

Most practices/clusters have adequate number of GPs e.g. via pooled clinical resources

Videoconferencing provided

Improved use of primary care team’s resources and safer use of medicines

Increased access to social prescribing opportunities

Improved satisfaction with services provided in General Practice

Quality assured Pharmacy First, with trained staff

Health behaviour change

GPs, including those previously in difficulty, feel supported in practice

Electronic patient call/notice boards provided

Greater patient knowledge of how to use medication

Decreased isolation

More efficient treatment by Pharmacist

Increased Practice Nurse knowledge and skills

Improved biomedical measures

Self-service check-in machines provided

Increased primary care capacity to manage patients

Increased Primary Care knowledge of MH services

Urgent Care GPs feel supported

Practice Reception staff trained to signpost

Good knowledge of patient at point of care

Helen Alexander


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3.2 Workstream 1 - General Practice & Community Redesign

Figure 1 – General Practice & Community Redesign Achievement Framework - version 13th June 2018

Helen Alexander


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Table 2 – Evidence of contributions to General Practice & Community Redesign outcomes (pink) and prerequisite processes (blue) Achievement/outcome Evaluation measure Data source Evidence of contribution to date Increased primary care capacity to treat patients

No. GP appointments avoided Workstream dataset

Of 878 appointed to MSK Physiotherapists, 534 were discharged to self-management,30 were appointed to a GP

No. unfilled* GP, ANP, PN appointments in Branchalwood

GP IT system Average 1,101 per month in 3/12 before NHS24 in hours triage, average 1,337 per month in 3/12 after NHS24 triage

Greater access to appropriately trained healthcare professionals

No. people attending ANP, MSK Physio. and OT appointments

Workstream dataset

1,475 seen by ANP, 878 appointed to MSK Physiotherapists 104 referrals to the OTs in two General Practices

Increased access to MSK Physiotherapy assessment, diagnosis and management

No. people receiving MSK Physiotherapy assessment, diagnosis and management

Workstream data

All 878 people who attended had MSK Physiotherapist assessment, diagnosis and management plan developed

Improved functioning i.e. occupational performance

Interviews with service users Qualitative data gathering

Interviewees described a range of benefits they had been motivated to pursue, including coping with stress/anxiety, connecting with services, and re-establishing social networks

GPs feel supported in practice Feedback from GPs Qualitative data gathering

Initial and follow up conversations with Branchalwood staff described how in hours triage was working, along with aspects to be explored at final session (being arranged)

Good patient knowledge of signposting options

Process – no. Reception staff trained to signpost

Workstream data

340 staff from 56 practices attended training sessions

Increased Practice Nurse knowledge and skills

Feedback from Practice Nurses Surveys Senior Nurse has surveyed Practice Nurses to identify topics they want to learn about and PN feedback from a recent educational event described learning new things

Improved satisfaction with services provided in Primary Care

Patients’ views of NHS24 in-hours triage

Qualitative data gathering

Patients were happy with the service provided by NHS24, with telephone advice, and with the outcome achieved

Patients’ views of ANP service Qualitative data gathering

Patients were very positive about the experience of attending an ANP clinic, felt the nurse was very helpful and thorough, and would be happy to see the ANP again

* These are appointments that are not pre-filled, rather they all get filled during the working day e.g. for urgent same day appointments Table 2 shows that a considerable amount of evidence was available for this workstream, demonstrating contributions towards achievement of many of the outcomes agreed for the first two years of PCMHT (represented in Figure 1). Not only were many healthcare professional services established in GP surgeries, but they were effective in achieving what they set out to do and the patients asked were positive about their experiences. It is worth noting that we are only claiming to have evidence of a contribution to outcome achievement, as there may be other influences on the results observed.

Helen Alexander


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3.3 Workstream 2 – Urgent Care

Figure 2– Urgent Care Achievement Framework – version 14th June 2018

Helen Alexander


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Table 3 – Evidence of contributions to Urgent Care (UC) outcomes Achievement/outcome Evaluation measure Data source Evidence of contribution to date Greater access to appropriate healthcare professional

Urgent Care resource hub established in Hamilton

Feedback from UC manager

Multi-disciplinary Hub established, working on multi-agency aspects at present

Improved response to mental ill-health

Outcome of calls that NHS 24 passed to Mental Health Nurse

Workstream dataset

1108 calls passed to Mental Health Nurse (Jan to Dec ’17) 22 (2%) needed seen by UC GP, 569 (54%) discharged back to existing care/own GP, 82 (7%) given emotional support. Police triage with MH nurse -60% less police time in Hairmyres

Fewer unnecessary paediatric hospital admissions & Scottish Ambulance Service transfers

No. children transferred from Urgent Care to Wishaw General

Urgent Care Paediatric Nurse dataset

Early data show 12% of children attending Urgent Care transferred to Wishaw General. 75% of attendees admitted, compared to 25% before Paediatric Nurse in Urgent Care

No. ambulance transfers from Urgent Care to Wishaw General

2.4% children transferred by ambulance from Urgent Care to Wishaw General

More efficient treatment No. calls dealt with by unscheduled care pharmacist

Pharmacist dataset

170 patient contacts during 16 Pharmacist sessions

Quality assured Pharmacy First, with trained staff

No. people advised by Community Pharmacist instead of Urgent Care Hub

Community Pharmacist returns

78 UTIs and 9 impetigo cases treated by Community Pharmacy during out-of-hours period in March 2018

Urgent Care GPs feel supported No. attending Urgent Care GP induction programme

Workstream dataset

All GPs joining Urgent Care staff attend induction programme

Good knowledge of patient at point of care

Availability of patient data via eEmergency Care Summary

Feedback from UC manager

eECS became available in Urgent Care in December 2016

Improved satisfaction with the Urgent Care service

Parents’ views of the Urgent Care service

Survey of parents

Early data showed that 70% of parents found the Paediatric Nurse presence beneficial, although only 46% felt the Urgent Care centre was accessible

Table 3 shows that a considerable amount of evidence was available for this workstream, demonstrating contributions towards achievement of many of the outcomes agreed for the first two years of PCMHT (represented in Figure 2). Not only was the new Urgent Care resource hub established, with dedicated mental health, paediatric and pharmacy input, but there was evidence of the Urgent Care GPs feeling supported parents being satisfied with the paediatric nurse presence in the hub.

Helen Alexander


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3.4 Workstream 3 – House of Care The House of Care (HoC) workstream was the first to develop an achievement framework and associated evaluation measurement table.

Figure 3 – House of Care Achievement Framework – version 4th April 2016

Helen Alexander


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Table 4 – Evidence of contributions to House of Care (HoC) outcomes Achievement/outcome Evaluation measure Data source Evidence of contribution to date Increased knowledge of long term conditions

Patient feedback Qualitative data After a care and support planning (CASP) consultation, 50 patients in one practice said that they now understood their health problems very well, only four said they did not

Increased ability to self-manage

A focus group held with the first lifestyle course cohort demonstrated that participants had changed their outlook on life and their health. Some noted that their confidence had been boosted by attending the course, in some cases motivating them to be involved in other activities

Good engagement with care planning

No. healthcare professionals (HCPs) who feel more confident about CASP after they have used HoC

On-line survey Although a small sample (n=5), HCPs’ confidence after the first HoC training session or after having used the HoC approach increases e.g. in allowing the patient to take the lead and drawing out the patients’ goals & action plan

More rewarding consultations

Healthcare professional feedback about rewarding consultations

On-line survey The five HCPs who had moved beyond their first HoC training session found their consultations quite or very rewarding, but this is too small a sample to draw conclusions from

Patient and carer feedback Patient questionnaire

From a total of 56 patients in one practice, 55 said they felt listened to during their CASP consultation and 54 had sufficient opportunity to say what they wanted to say

Health behaviour change

Rates of change in physical activity levels, smoking status

GP IT system 94% increase in light/moderate exercise levels (n=848 cf. 436) in year after CASP compared to the year before. Almost a third more lost weight in the year after compared to the year before

Improved biomedical measures

Change in individual biomedical measures

GP IT system One third more people had lower cholesterol than higher in the year after CASP compared to the year before

Decreased demand on GPs

GP consultation rates per year for patients involved in HoC before and @ 1,2 & 3 years after CASP

GP IT system The average no. times people consulted their GP was higher (9.8 times cf. 7.9) in the year after CASP than the year before, as expected. It will take longer to achieve this outcome

In addition to evidence of increased knowledge and behaviour change (for people with long term conditions and healthcare professionals), Table 4 shows that more people who participated in a Care and Support Planning (CASP) consultation increased their level of physical activity than decreased it and more lost weight than gained. More people also had lower cholesterol by the end of the year after CASP than higher. Given the numbers involved, it is likely that House of Care has made a contribution to them achieving this, and more longitudinal data would increase confidence in this finding. This is important as a perception exists that HoC has not delivered sufficient benefits to practices. We need to continue to gather robust evidence to support or refute this view.

Helen Alexander


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3.5 Workstream 5 – Recruitment and Retention

Figure 4 – Recruitment and Retention Achievement Framework – version 7th August 2017

Helen Alexander


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Table 5 – Evidence of contributions to recruitment & retention outcomes (pink) and prerequisite processes (blue) Achievement/outcome Evaluation measure Data source Evidence of contribution to date Practice closure assessment tool developed

Closure assessment tool finalised Workstream dataset

Tool developed

Closure risk assessed for all practices

No. practices assessed for risk of closure

Workstream dataset

Risk of closure assessed for all Lanarkshire practices. One high risk of unsustainability, 19 medium risk, remainder low risk. This assessment was then used to inform decision-making for additional support

Good understanding of GP recruitment and retention issues, including risk of practice closures and why GPs leave posts in Lanarkshire

No. exit interviews completed with Lanarkshire GPs


GP appointed to conduct exit interviews and will share anonymised themes identified

Corporate advertising strategy in place

Workstream lead feedback

Successfully recruited a GP as a result of the tailored advertising strategy

Most practices/clusters have adequate number of GPs e.g. via pooled clinical resources

Description of pooled clinical resources and other supportive cluster arrangements

Workstream lead feedback

One cluster has arranged cross-cover between practices for short periods of time.

GPs , including those previously in difficulty, feel supported in practice

Evaluation of GP coaching programme

FMLM report 10 GPs successfully engaged with the coaching programme

Description of supports available Workstream lead feedback

The team has developed tailored solutions to respond to practices in difficulty, including available Locality resources. At time of information gathering, there were no 2C practices

Table 5 shows that some good evidence was available for this workstream, demonstrating contributions towards achievement of many of the outcomes agreed for the first two years of PCMHT (represented in Figure 4) and prerequisite processes. Risk of closure across all practices was assessed, there was a good understanding of the issues involved, one cluster had shared cross-cover for short periods of time and 10 GPs were successfully engaging with the coaching programme developed to support them in practice. At the time the evidence was gathered, the available supports had been deployed to avoid there being any 2c practices in Lanarkshire.

Helen Alexander


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3.6 Workstream 6 – GP Digital Services The outcomes for this workstream cannot be achieved until the technology is in place, hence the need to measure the pre-requisite processes.

Figure 5 – GP Digital Services Achievement Framework - version 29th March 2018

Helen Alexander


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Table 6 – Evidence of contributions to GP Digital Service processes Prerequisite process Evaluation measure Data source Evidence of contribution to date Provide online access to book appointments

No. of people booking online appointments

GP IT system report

23 of the 30 practices supported via GP Digital funding are now enabled for on-line appointment booking and/or prescription ordering (96 of Lanarkshire’s 104 practices)

Provide online access to order repeat prescriptions

No. of people ordering prescriptions on-line

By Dec ’17, 14,004 people in 75 practices had booked an on-line appointment, 76,844 had ordered a prescription on-line

Provide Vision Anywhere (mobile working)

No. of clinicians using Vision Anywhere (VA)

IT Facilitator dataset

40 practices across all 10 Localities have received at least one VA tablet

Clinician feedback on Vision Anywhere (VA)

On-line survey 14 of the 29 survey respondents had used their VA tablet and eight had found this easy. The feedback requested in this survey will inform future developments

Provide video conferencing

No. of clinicians using video conferencing


22 practices have had videoconferencing software installed and Cluster Quality Lead GPs have used it for meetings

Clinician feedback on videoconferencing (VC)

On-line survey Although the sample size was small, VC was found to be easy to use and it avoided travelling to meetings/appointments

Provide electronic patient call /notice boards

No. of practices using electronic patient call/notice boards


24 practices across all 10 Localities have received electronic patient call/notice boards

Clinician feedback on electronic patient call/notice boards (PCN)

On-line survey 12 of the 14 survey respondents said that the PCN had been useful to their practice. The detailed feedback requested in this survey will inform future developments

Provide self-service check-in machines

No. of patients using self-service check-in machines


27 practices across 9 Localities have received self-service checking machines

Clinician feedback on self-service check-in (SC) machines

On-line survey 20 of the 21 survey respondents said that the SC machine was useful to their practice. Patients did not always complete the check-in process or ignored the printed instructions and some machines did not work as planned. The detailed feedback requested in this survey will inform future developments

Outcomes achievement is dependent on the technology being delivered and functioning as planned

Table 6 demonstrates evidence of contributions to the prerequisite processes i.e. technology deployment/functionality, that need to be in place before the agreed outcomes can be achieved. It took considerable effort to provide these digital solutions and practices generally felt they improved service provision. It would be useful to put the numbers into context e.g. comparing the number of on-line and telephone appointments, informed by patient preference.

Helen Alexander


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3.7 Workstream 7 – Pharmacists in Practice A number of pre-requisite processes were agreed for this workstream before some of the outcomes could be achieved.

Figure 6 – Pharmacists in Practice Achievement Framework – version 10th August 2017

Helen Alexander


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Table 7 – Evidence of contributions to Pharmacists in Practice outcomes (pink) and prerequisite processes (blue) Achievement/outcome Evaluation measure Data source Evidence of contribution to date Range of activities agreed for each practice

No. of each activity agreed for each practice

Workstream dataset

GPCP roles spreadsheet quantifies the activities agreed for each practice

No. General Practice Clinical Pharmacists (GPCPs) trained

No. Pharmacists completing training

Workstream dataset

23 pharmacists attended NES training

No. Pharmacists in Practice undertaking each activity

No. Pharmacists undertaking each activity in their practice

Workstream dataset

23 pharmacists currently supporting 22 practices across NHSL


Total Pharmacist time spent in practice

Workstream dataset

1418 days to Nov ‘17

Total time spent running clinics or telephone consultations

Workstream dataset

Running clinics: 148 sessions + 55 hours face-to-face time (to Nov ‘17) Telephone consultations: 246 hours (to Nov ‘17)

Greater practice staff knowledge of Pharmacist role in practice

Views of practice staff Interviews with GCPC cohort 1

Typical quotes include, ‘I know they’re a hundred per cent sure what I’m doing’ and ‘I’ve had feedback from one of the GPs …. she said our role is increasing safety in the practice’

Improved use of team’s resources and safer use of medicines

No. medications stopped, switched, added

Workstream dataset

Total read codes for January – June 2017: Medication changed: 458 Medication commenced: 972 Drug therapy discontinued: 326 Medication recommenced: 77

More standardised prescribing More people on optimal medication regimes Fewer adverse medication reactions and interactions Greater patient knowledge of how to use medication

Total no. patients given advice Workstream dataset

Total read codes for January – June 2017: Discussed with patient: 556

Increased primary care capacity to manage patients

Views of primary care staff, including GPCPs

Interviews with GCPC cohort 1

Interviewees described various aspects of their role that used to be carried out by GPs e.g. discharge/outpatient letters, acute prescription requests. Also GPCPs have started running their own clinics e.g. to review polypharmacy

During PCMHT, the Pharmacists in Practice workstream transitioned to become the Pharmacotherapy workstream of the Primary Care Improvement Plan. Table 7 therefore contains the last evidence that was gathered for PCMHT, although the evaluation is ongoing. There was considerable evidence of contributions towards achievement of many of the outcomes and prerequisite processes agreed for the first two years of PCMHT (represented in Figure 6).

Helen Alexander


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3.8 Workstream 8 – Mental Health

Figure 7 – Mental Health Achievement Framework – version 7th June 2018

Helen Alexander


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Table 8 – Evidence of contributions to Mental Health outcomes Achievement/outcome Evaluation measure Data source Evidence of contribution to date Decreased mental health stigma Clozapine Pharmacy signed up to

Stigma-free Lanarkshire Pharmacy feedback

Pharmacist confirmed this practice is signed up to Stigma-free Lanarkshire

Improved health literacy Case studies Pharmacy feedback

Clear evidence of Pharmacies responding to training by improving access to health information and explaining it

Improved relationships with clients

Case studies Pharmacy feedback

Clear evidence from a range of cases of Pharmacist engaging with people over time, responding to needs, observing change

Increased access to social prescribing opportunities

Referral reason MH Link workers/SAMH

Of 1,177 referral reasons known, 25 were for physical health, 849 for mental health

Signposting Of 984 inclusion supports signposted to, 227 were to a range of existing services, 535 to mental health services

Decreased isolation Referral reason MH Link workers/SAMH

Of 917 referrals refined by Link Workers, 81 were for isolation Signposting Of 823 enhanced supports signposted to, 172 were for peer

support. 542 were to third sector organisations Increased Primary Care knowledge of Mental Health services

Feedback from practices with a Mental Health Liaison Nurse

MH Liaison Nurse dataset

1,033 contacts to date, GP felt ‘more knowledgeable about resources available’

Improved access to health screening

No. people seen by the MH ANP accessing health screening

MH ANP dataset 2 MH ANPs in post, identifying which practices will be based in

Improved service user and carer knowledge of dementia and available supports

Views of people with dementia and their carers


Web site structure agreed, demonstration & feedback session being organised

Shorter waiting times for psychological therapies

Behavioural Activation Therapy (BAT) test lead feedback

BAT test lead Interview with BAT test of change lead captured the experience to date and why this was not the right time for it

Table 8 shows that a considerable amount of evidence was available, demonstrating the contributions towards achievement of many of the outcomes agreed for the first two years of PCMHT (represented in Figure 7). This workstream had encountered some difficulty establishing a few of the new services it was testing, but by the end of PCMHT, it had gathered an impressive range of evidence from different sources. This included introducing Behavioural Activation Therapy into Primary Care, which is successful in hospital settings, but which it was agreed would fit better once multidisciplinary teams had been established under the Primary Care Improvement Plan i.e. at a later date. However, having a range of mental health services based in practice appears to have had a positive impact on primary care knowledge of the available resources.

Helen Alexander


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4 EVALUATION CONCLUSIONS This report presents an overview of evidence to support the claim that a considerable amount was achieved by Lanarkshire’s Primary Care and Mental Health Transformation Programme (starting from July 2016). In particular, Table 1 summarises the contributions of the seven workstreams to achieving the evaluation outcomes agreed by them. Although this should be viewed as early evidence of success, which will need to continue to be evaluated under the Primary Care Improvement Plan (PCIP), we know that Primary Care now has increased capacity to manage patients (from the Advanced Nurse Practitioners, Physiotherapists, Occupational Therapists, Pharmacists, Specialist Nurses, and Link Workers practising autonomously), that patients have greater access to appropriately trained healthcare professionals and are generally satisfied with the new services, and that GPs are beginning to feel more supported e.g. by new digital services and some tailored solutions to the difficulties they are facing. In addition, there is early evidence of health behaviour change and improved biomedical markers for people engaging with Care and Support Planning (CASP), a considerable number of practice Reception staff have been trained to signpost, and there has been an increase in Primary Care knowledge of mental health services and access to social prescribing. It took a lot of time, commitment and attention to detail to create and revise seven achievement frameworks and their associated evaluation measurement tables. But, having done this meant that Lanarkshire had a clear set of outcomes for its PCMHT workstreams, and a strong sense of the evidence required to demonstrate their achievement. These can now be further developed to align with the PCIP, providing a good basis for the ongoing evaluation, in collaboration with the Improvement Support Team. It should be remembered that PCMHT in Lanarkshire was a major programme of work that required considerable efforts from a large group of people just to establish and test the new ways of working. One of the issues encountered that caused delays was related to recruitment to new posts, the timescales for which were often lengthy. Given the scope of the changes introduced, those responsible for them and the associated data gathering should be applauded for the amount of evidence available for this evaluation. Much was expected of this programme, and a wealth of information was able to be produced to demonstrate its success to date. Due to the shear volume of tests of change implemented by each workstream, it was not possible to include one aspect of the Contribution Analysis method i.e. any challenges to claims of outcome achievement. This would normally increase confidence that the findings were due, at least in part, to the tests of change, by surfacing any alternative explanations for the results observed. Testing whether or not there is evidence to support or refute such rival explanations will be an important part of the evaluation of PCIP. In preparation for transitioning the evaluation into PCIP, it is recommended that:

1. The evaluation team continues to work collaboratively with the Improvement Support Team and individual workstream representatives to ensure the necessary evidence is gathered for the PCIP

2. The PCIP is regularly informed by updates, so the Primary Care Strategy Board should request six monthly evaluation reports

Helen Alexander

Documents

Lanarkshire’s Primary Care and Mental Health …...3.6 Workstream 6 – GP Digital Services 11 3.7 Workstream 7 – Pharmacists in Practice 13 3.8 Workstream 8 – Mental Health