Transcript Establishing a Managed Care Network for Hepatitis C

Justin Schofield
Hepatitis C MCN Manager
NHS Greater Glasgow & Clyde

Phase II Action Plan
Aim:
 Evidence
Provide overview of the
process for establishing a
hepatitis C MCN
 Strategic direction
 Investment
 Cross-cutting priorities &
actions


MCN core principles

Management arrangements

Identify stakeholders

Map patient journeys

Annual work plan
 Where to start?

Service standards
 Who to engage with?

Quality assurance

Risks & potential benefits
Hepatitis C MCN
 Co-ordinated approach to
service development
 New ways of working
 Improve service to patients

Content:
Health Boards & partners
 How to manage process?

A Managed Care Network is:
 A linked group of health
professionals & organisations,
 working in a co-ordinated manner,
 unconstrained by existing
professional and
organisational 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
5.
 Lead Clinician
 Network Manager
2.
Structure
 Multi-disciplinary & multi-
professional
6.
 Patient pathway
3.
4.
Activities
Outputs
Benefits to patients
Annual report
Evidence base
meaningful participation
7.
Quality Assurance
 MCN accreditation
 Clinical governance, audit, risk
management, patient safety
8.
 SIGN
 Clinical audit & research
findings
 National & local evidence
of need
Patients & vol. sector
 Supported to enable
Annual work plan




Membership
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
2: Management arrangements

Lead Clinician
“… overall responsibility for the
functioning of the Network” HDL(2007)21
 Reflect role in Job Plan
National forums


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 Plan
i.
ii.
iii.
iv.


Prevention
Testing, treatment, care & support
Co-ordination
Training, education & awareness raising
Budget-holder
Strategic overview
National Hepatitis C MCN
Clinical Leads’ Group
(in development)
• Share information, learning,
resources & best practice
• Avoid duplication of effort
• Agree national standards
National Hepatitis C
Executive Leads Group
(in existence)
• National co-ordination &
performance monitoring
• Communication with HPS
& Government
3: Identify stakeholders
Testing & Referral
Health Board
Primary
Care
Prison
Drug
Services
Public
Health
Health
Improvement
Public / Patient
Involvement
Inpatients
GUM
Maternity
Services
Finance
Training
BBV Prevention
Planning
CHPs
Other MCNs
Specialist Care
Infectious Diseases
Hepatology
Gastroenterology
• Ultrasound
• Dietetics
• Psychology
• Psychiatry
• Laboratory
• Pharmacy
• Service Mgrs





Vol.
Sector
Drug
Services
Prison
Social
Care
Mental
Health
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
Care & Support
Primary
Care
Stakeholders

Stakeholder analysis informs:

MCN structure & membership

Communication strategy
4: Map patient journeys
Testing & Referral
Primary
Care
Prison
Inpatients
GUM

Drug
Services

Maternity
Services

Hepatology
Gastroenterology
• Ultrasound
• Dietetics
• Psychology
• Psychiatry
• Laboratory
• Pharmacy
• Service Mgrs


People & information
Specialist Care
Infectious Diseases
Identify



Available evidence





Care & Support
Primary
Care
Drug
Services
Social
Care
Vol.
Sector
Prison
Mental
Health

Key service providers
Available resources
Patient & information flows
Barriers along journey
Service pressures
Gaps = opportunities for
development
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
5: Annual workplan
MCN DEVELOPMENT
 Communications
SERVICE DEVELOPMENTS
 Priorities informed by


Web site
Communication with
stakeholder groups
 Annual report

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
National Action Plan
Local mapping

Define activities, outputs,
& benefits to patients

Develop infrastructure
Membership & Structure








Clinical staff resources
Outpatient clinic space & locations
Outreach staff & settings
Agreement with partner agencies

Pilot / launch developments

Monitoring arrangements




Activities
Outputs
Outcomes
User satisfaction
6: Service standards

Used to asses MCN performance

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

National standard for hepatitis C
services



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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.
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
7: Quality assurance

MCN Accreditation
 NHS Board accredits local
MCNs
 Existing process & support

MCN must demonstrate:

QIS Quality Assurance
toolkit*
 Overview
 Guidance
 Templates
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
* Toolkit provided with this presentation
7: Quality assurance
MCN Accreditation Timetable: Yrs 1 & 2
Year 2: 2009
Year 1: 2008
• Secure stakeholder involvement
• Define work programme
• Secure public / patient involvement
• Refine priorities
• NHS Board endorsement
• Establish education programme
• Define MCN structure
• Establish audit and research programme
• Define patient pathway
• Formal launch
• Agree priorities & key improvement measures
• Assess progress against QIS Quality
Assurance model
• Define the MCN communication strategy
• Report progress to Board
• Assess progress against QIS Quality
Assurance model
• Report progress to Board
Risks and benefits
RISKS

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
BENEFITS

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
Key messages