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Improving neurology services a user guide
DEBateman NCD Neurology 8 Nov 2015
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• Major transformation of NHS
• NHSE formation
• Purchaser provider split
• Radical new approach
• Quality & outcomes framework
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Health & social care act 2012
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High quality care
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• Domain 1 preventing premature death
• Improving acute services treatment
• Preventing recurrence after an acute
event
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Measurement
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• Generic approach with House of Care
• Good primary care
• Integration of care particularly with social
care
• Integration of physical & mental health7
Domain 2Enhancing quality of life for people with LTC
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• 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
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Domain 3Helping people recover from episodes of acute
ill health
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CCG Outcomes framework
No neurology ones!
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• 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
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• 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
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Commissioning
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• Specialised
• CCG
• Collaborative
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• Epilepsy surgery assessment
• Surgery for movement disorders
• Diagnosis of rare neuromuscular
disorders
• Neurogenetics13
Specialised commissioningNeurology
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• THE REMAINDER!
• All MS services including DMT
• Collaborative part of the change
• All GP referrals April 2015
• IP work local identification
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CCG
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5YRFV
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These Mult-ispecialty Community Providers (MCPs) would become thefocal point for a far wider range of care needed by their registeredpatients.
• As larger group practices they could in future begin employingconsultants 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 consultationsand ambulatory care out of hospital settings.
• They could take over the running of local community hospitals whichcould substantially expand their diagnostic services as well as other
services such as dialysis and chemotherapy/DMT for MS
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Neurology multi-speciality clinic
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• 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
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Acute neurology admissions
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• 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?!
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• Large DGHs• Acute neurology centres with acute stroke• Joint rota• Urgent clinics• TIA clinics• Shared ward base & staff• Shared rehabilitation
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7 day working
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Summary
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• Multi speciality neurology
provider
• Re-organise acute care
• Collaborative commissioning
• Value better care for less
money
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• 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
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Value for neurology servicesbetter services at less cost
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• CCG commissioning
• Clinical networks
• Care pathways
• Value driven care
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Levers & incentives
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• 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?
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Right care
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• Importance of care pathways
• Networked care
• Single contact & point of
access
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Organisation of care
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• Patients & charity & in charge
• Organised around patients not doctors or centres
• Community & DGH
• DESCRIBE CARE PATHWAY
• Comprehensive service
• diagnosis, DMT & 2 progressive
• standards & milestones
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MS services
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• How many patients?
• Time to diagnosis
• Time to treatment
• % of total on DMT
• % of R&R on DMT
• Complication rate
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250-500k population
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• 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
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Criteria for DMT provision
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• Diagnosis
• Information & support
• Coordination of care
• MS symptom management & rehabilitation
• Relapse treatment
• Quality standards Jan 2016
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Nice guidance
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Examples of good practiceMS trust awards
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• Multidisciplinary teams• GPwSI with integrated social
work• Adult ability team• Pathway redesign • Local OP rehabilitation service• Better information• Evidence into practice
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NHSE community neurology project
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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
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RCGP care & support planning
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• 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
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• CN & NIN
• CCG commissioning
• 5YRFV
• Levers & incentives
• Examples of good practice
• Dedicated charities & clinicians
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Summary
