Transcript ADHD_Coventry_onepager_project_overview

A joint working project between Lilly and Coventry and Warwickshire Partnership NHS Trust to
support the Transition of Care for young people with ADHD within Coventry and Warwickshire.
INTRODUCTION
Coventry and Warwickshire NHS Partnership Trust (CWPT) covers a
population of around 908,000 people, with culturally diverse and complex
needs and financial challenges across the health economy. During
2013/14 ADHD was being managed via CAMHS with a Shared Care
Agreement (SCA) for ongoing prescribing of medications. These
arrangements did not cover any adult prescribing, as there were no
transition or adult ADHD services commissioned.
Some patients with ADHD may have complex needs necessitating the use
of significant resources and the involvement of different agencies, whilst
others may be more less complex in nature. In Coventry and Warwickshire
there was an emerging desire from GP’s to develop a pathway for
transition of patients into adult services and to consider the diagnosis and
treatment of adults with ADHD. A treatment pathway was agreed across
the health economy for transition patients from CAMHS.
A subsequent CQUIN (payments framework encouraging care providers to
share and continually improve how care is delivered being developed) for
the financial year 2014/15 for CWPT, with the aim to implement and
evaluate this transition pathway.
Following initial meetings, work streams were identified with roles and
responsibilities specified including where industry should and should not
be involved. The work streams were based on the ADHD transition
pathway, which had been previously agreed by commissioners and the
Area Prescribing Committee (APC). These were;
• Documents to support primary care for the ongoing responsibility for
non-complex patients.
• Documents to support complex patients whose care would remain in
secondary care.
• Competency framework for education to support any education to
primary care around ADHD and the transition service.
• Business case to commissioners for the development of a diagnostic
and treatment of adult ADHD service.
• Supporting CQUIN delivery through CQUIN meetings
While Lilly were not project managers for this CQUIN, they were able to
bring project management skills to the chief pharmacist, including the
development of a project plan and communication plan alongside the
existing CQUIN documentations.
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OUTCOMES
CQUIN milestones were delivered for 2014/15 and the CQUIN was expanded into
2015/16. The information below summaries the overall outcomes for each work
stream.
Workstream
As the pathway was established, there was a need to rapidly
implement, whilst developing various resources to support the pathway.
Outcome
• The production of an ADHD guide for
non-specialists.
Documents to support
• Specialist Initiation in Drug Checklist to
primary care for the
be used by CAMHS consultants and
ongoing responsibility
given to GP’s on referral to ensure patient
for non-complex
are non-complex in nature.
patients
• Both documents were approved by the
APC and are hosted on their website.
Part way through this process, the trust Chief Pharmacist and Lilly
agreed that there would be significant benefit to patient and mutual
benefit between both organisations to support the ABPI defined joint
working process. The contract started from July 2014 and completed
at the end of March 2015.
Documents to support • The production of shared care
complex patients
agreements for medications used for the
whose care would
treatment of ADHD.
remain in secondary
• Documents approved by the APC and are
care.
hosted on their website.
The idea was not only to help the delivery of the CQUIN but to also
show the value Lilly can bring to the trust through joint working, with
evaluation of the ‘joint working experience’ an important element.
Competency
framework for
education to support
any education to
primary care around
ADHD and the
transition service.
What is Joint Working?
The Department for Health (DH) and the Association for British
Pharmaceutical Industries (ABPI), summarised joint working in their
moving beyond sponsorship toolkit in 2010.
Joint Working describes situations where the NHS and pharmaceutical
companies pool skills, experience and/or resources for the benefit of
patients and share a commitment to successful delivery. In joint
working, goals are agreed jointly by the NHS organisation and company,
in the interest of patients, and shared throughout the project. A joint
working agreement is drawn up and management arrangements
conducted with participation from both parties in an open and transparent
manner.
AIMS
• Competency framework developed via
clinical input from consultants and GP
specialist.
• Documentation with CWPT to be used in
future education meetings.
METHODS
Through the commissioning process, Coventry and Warwickshire Partnership
Trust (CWPT) had set up an ADHD transition CQUIN working group, to
focus on delivering CQUIN milestones and delivery of the ADHD transition
service. Lilly’s role in project support was to support the delivery of quarterly
CQUIN milestones via CQUIN project plan and review process and monthly
review meetings with CWPT chief pharmacist. The project oversight and
organisational structure is seen below;
UKSTR01027a
August 2015
CONCLUSION
“This project has demonstrated the benefits of collaborative or joint
working between the NHS and Lilly. The mechanism of joint working
allows to develop projects which are the benefit to patients, to the NHS
and to industry. The feedback from the staff survey illustrates the change
in perception and benefits this way of working from pre-contract to
completion.
This CQUIN would clearly have continued without Lilly’s input, however the
creation of capacity through the Lilly Healthcare Development Manager
added an external focus of business acumen and experiences from other
areas.
Business case to
commissioners for the
• Business case developed and submitted
development of a
to commissioners. The service was not
diagnostic and
funded for 2015/16.
treatment of adult
ADHD service.
I have been absolutely delighted with Lilly’s input into this project. David
became just one-of-the-team. Whilst he was working to me in a line
management capacity, the governance controls afforded by the formal joint
working agreement meant that I was also confident for him to also work
independently and feedback to me.
Supporting CQUIN
delivery through
CQUIN meetings
His business acumen clearly identified key deliverables , many of which he
delivered with either minimal or no direct supervision. I feel it was a major
success that both myself and colleagues reached a level of
confidence/trust/respect very early on that meant we were more than
happy for David to also work independently as required. It was just like
working with another colleague. He was professional, knowledgeable,
reliable and effective.
• Development of screening questionnaires
for staff and patients evaluation.
The project aims were developed to deliver benefits firstly for patients but
also to deliver benefits for the NHS and Lilly UK. These aims were to:
• Support CWPT Chief pharmacist to ensure delivery of CQUIN on ADHD
transition
• Support mapping of current patient journey (‘As is’ ) and proposed
journey (‘To be’)
• Identification of gaps and resources required to achieve the ‘To be’
pathway
• Provision of business information and support for CWPT and assist in
review of business case documents.
• Development of education and training framework for primary care.
• Support solutions for evaluation and audit through CWPT CQUIN.
• I feel that as long as there are appropriate safeguards in place with
respect to the potential commercial gains and links when working with
Pharma, there can we a future for co-working between commissioners
and the Pharma Industry.
• Would see this type of working as a beneficial for future projects.
• This collaborative work has been extremely helpful & productive.
• They were one of the team.
• They seemed to be a very good support to medicines management.
• I think David (Lilly) was a really positive asset and worked
constructively with the whole CQUIN Team. He was very focused,
supportive and met expectations.
• Very positive experience generally.
• It helped that the individual was knowledgeable on ADHD, pleasant
and committed to moving it forward for the benefit of patients. He also
attended all the meetings and liaised well with Chief Pharmacist.
Staff Survey
Following the project closure, all NHS staff where Lilly had interacted
were requested to respond to survey with 9 people responding as
below;
Prior to starting this work, what were your opinions of working with
Pharmaceutical industry?
• I have always found working with Pharma in terms of education and
research to be an essential part of medicine and patient care, but have
to keep a weather eye out for separating the commercial interests of
Pharma with their health care remit.
• Can be useful sometimes.
• No strong views but probably would have expected that the industry
would be supplying help for something in return.
• It can be a helpful alliance.
• Sceptical.
• Broadly positive, but a bit reticent regarding close working.
• I was cautious.
• Had previous positive collaboration with Lilly.
• Thought it was basically driven by profit and isolated from NHS.
The help to myself was perfect. It really was just like having another team
member. The delivery of our ADHD CQUIN would have been a lot more
difficult without him.
He attended our CQUIN management groups as an equal – and was
rapidly accepted as such by the other CQUIN group members.
The Joint Working Agreement gave everyone concerned (re)assurance of
probity. I would recommend this approach to other NHS organisations.”
David Tait
Authors;
David Godfrey
Healthcare Development Manager - Eli Lilly & Company Ltd
[email protected]
David Tait
Chief Pharmacist - Coventry and Warwickshire NHS Partnership
Trust
[email protected]