TVSCN > Medical Director Update – Hampshire – IOW/Thames Valley 2018/19

Medical Director Update – Hampshire – IOW/Thames Valley 2018/19

Dear colleagues,

Welcome to the first issue of Hampshire/Thames Valley Medical Directorate Newsletter. As some colleagues will know, we have been producing a South Central newsletter for some time now; however on 1 July, I took on responsibility for the Hampshire and Isle of Wight area as well as the Thames Valley and my colleague Liz Mearns has taken over responsibility for the new South West (North) patch.

Congratulations to our colleague Aarti Chapman, who has been seconded to the South-wide Head of Strategy and Transformation role and thanks also to Sally Rickard who extends her  role as lead for the Wessex SCN  and Senate team, to support the Thames Valley team, and to Wendy McClure for providing local leadership for the Thames Valley team.

The start of 2018/19 has been a busy period; colleagues in NHS England and NHS Improvement are continuing to work ever more closely together and to speak to systems with a united voice. At a national level PHE have established the National CVD Prevention Systems leadership group and are working with colleagues to develop a National CVD prevention ambition.

The South Central Leadership Forum continues to go from strength to strength. We recently received excellent presentations from Professor Bee Wee about her role as the National Clinical director for End of Life Care, Sangeeta Saran about how East Berkshire have seen amazing results in preventing CVD and Noel Burkett about how Buckinghamshire is developing its Integrated Care System.

On 4th July we launched our South Central Clinical Leadership Development Programme for 70 primary care leaders across the patch. It was a great day facilitated by the NHS Horizons team which brought together a community of fantastic leaders.

. The Thames Valley Network and Senate team ran the South Central Medical Directorate Conference in June for well over a 100 delegates. We had an outstanding array of speakers including Professor Tony Young the NCD for Innovation, Professor Sir John Bell who talked about the 100,000 Genomes Project, Norman Lamb sent us a message on Artificial Intelligence and Christine Blanshard on how Salisbury dealt with their recent situation. My huge thanks to the members of the Thames Valley SCN and Senate for all their effort in delivering such a successful event.

It is fantastic to see so much of the NHS in the media as we celebrate our 70th birthday. I feel truly humbled to have the opportunity to work with such fantastic colleagues in what I believe to be the most amazing organisation in the world.


Reflections on Clinical Leadership – Frimley 2020

I am pleased to be able to share feedback I have received from the excellent and positive work that is being achieved through the clinical leadership “Frimley 2020” programme. Core to the programme is working on a “change challenge” and I am delighted that Dr Ottilia Spiers, Consultant Stroke Physician and Geriatrician has been kind enough to share her experiences of that work and the wider benefits Frimley 2020 has offered her;

“Don’t let the day to day details make you lose sight of the bigger picture”

The above was advice given to me by a 2020 colleague. I am the clinical lead for stroke at Frimley Park Hospital and had been participating in a Surrey Stroke Service review process since 2014. Its aim was to consider how to provide the safest and most effective services for the Surrey population meeting the standards set out in the National Stroke Strategy.  The recommendations initially were for a co-located HASU/ASU service at Frimley Park Hospital for a larger catchment area including part of the neighbouring Royal Surrey County Hospital (RSCH) trust catchment.

When I started the 2020 leadership programme I can honestly admit that I had become frustrated and overwhelmed with the process above.  I felt that change was happening but I wasn’t able to influence it.   The process had led to uncertainty and a fall in morale with the subsequent loss of staff from the neighbouring trust. As a result we needed an interim solution when a neighbouring trust ceased to be able to provide acute stroke care.

I entered 2020 not knowing how I could influence change and whether I actually had the skills and courage to do it.  The 2020 group gave me the confidence to explore my frustrations with others, and to reflect on how I was reacting to the situation.  The 2020 sessions allowed me the time to step outside of the situation and to gain fresh insight.  The exposure to inspirational leaders and change-makers challenged my views on who could be a leader. I was able to draw on fellow delegates’ experiences and to be inspired by the innovative changes they had implemented.  Each delegate came with a change-challenge and we worked together to support each other.  I realised that I needed to focus on making the pathway patient-centred, providing first class hyperacute stroke services with rehabilitation closer to home.

Working collaboratively with the stroke team at RSCH we set up an interim pathway providing 24/7 HASU care at Frimley Park Hospital with an ASU at RSCH.  Having listened to patients and relatives at public consultations we understood that people were prepared to travel for emergency services but during recovery and rehabilitation they needed the support of friends and family closer to home.  We were able to demonstrate to the CCG that this network approach was feasible and that we were able to deliver excellent care for our patients. As a result we are now finalising the details of the service that will be commissioned by the CCGs.


Primary Care Leadership – NHS @2030 – “Strengthening Leadership Skills”

On Wednesday 4th July the first event of the South Central Primary Care Leadership Programme was held in Reading.

Around 70 leaders from across primary care attended the event that launched this new and innovative leadership programme.

The event was an accelerated learning event, run by NHS Horizons where participants were encouraged to think innovatively and differently about leadership.   Groups discussed some of the major challenges facing the NHS at the moment.

There was an incredible amount of positive energy and enthusiasm in the room,  which really enabled participants to share thoughts about the challenges.

Some of the key phrases and topics that came out of the day were around passion, collaboration, joining up with a real “can do” attitude in the room.

A WhatsApp group has been established and a number of resources have been put on the website. A number of the participants have completed 360’s and others have begun to access the online resources from the Leadership Academy including the Edward Jenner programme.

The next session is in September but there is plenty of work going on between then and now. http://www.nhscollaborate.org/south-central-gp-leadership-development-programme/  


Public Health – Child Health and Wellbeing

New measures to halve the number of obese children by 2030 were announced by Health and Social Care Secretary Jeremy Hunt on 24 June and with this recent announcement I am pleased to see Public Health England colleagues are supporting this work across not only childhood obesity, but the wider child health and wellbeing agenda.

Child Health profiles have been released which presents data across key health indicators of child and health and wellbeing.  This set of profiles are provided to help local organisations understand the health needs of their community and aid partnership working.

Last month, PHE launched their latest data on the density of fast food outlets by local authority. This is an important set of data as it highlights the potential links to fast food outlets in proximity to schools as well as further strengthening the link between prevalence of fast food outlets to more deprived areas.

​With national recommendations that children do at least 60 minutes of moderate to vigorous physical activity every day (with just 23% of boys and 20% of girls aged 5 to 15 years currently meeting this recommendation), Change4Life have again partnered with Disney, with the support of Sport England to launch a brand new “Train like A Jedi” activity programme which uses the excitement of Star Wars, alongside Double Olympic Gold medallist Jade Jones – to encourage children to Train Like A Jedi and increase their levels of physical activity.


Perinatal Mental Health

Thames Valley SCN’s Perinatal Mental Health team are supporting the South’s region ambitions aligned to the FYFV. Not only are new specialist perinatal mental health services in place or commencing, it is also very satisfying to see other developments relating to the support of this potentially vulnerable population and their children.

BU WebBeds

Work in Wessex has created a national online Mother and Baby Unit (MBU) bed management tool that has eliminated unnecessary delays in the referral process. MBUs are acute mental health wards where women can be admitted with their babies. Prior to WebBeds, MBU staff spent time dealing with phonecalls about potential referrals even if their MBU was full. The new website shows up-to-date bed availability in MBUs across England, updated daily, for referrers to see the location of their closest MBU with an available bed. Working with the national team, a new universal MBU referral form has been developed which will be available via WebBeds, making the referral process quicker and easier and helping women to access time critical care.

Perinatal Mental Health Matrix

TVSCN has been developing and implementing a web tool for providers and commissioners to  measure current and proposed services against both quality (NICE Quality Standards for Antenatal and Postnatal Mental Health QS115) and workforce (Royal College of Psychiatrists workforce standards CR197). This collection of indicators has been endorsed by NICE and it is listed as a resource on the NICE website.
https://www.nice.org.uk/guidance/qs115/resources .

Data is collected about service provision, workforce, and meeting Quality Standards. It is applicable to midwifery, health visiting, IAPT, Adult Mental Health as well as to specialist Perinatal Mental health services. The Matrix can be accessed at https://matrix.tvscn.nhs.uk (registration required to access data).  This work is now being rolled out across all parts of the South under the leadership of Thames Valley SCN.

Reducing Stillbirth in Wessex

A recent region wide audit and introduction of a review panel has been recently introduced in Wessex aimed at assessing current stillbirth trends. This work was undertaken through a clinical team working across teams in 8 provider trusts. The audit and interview findings highlighted;

  • A wide variation in practice of assessing fetal growth
  • Deficiency in basic training (fundal height measuring)
  • 55 stillbirths between January and June 2015 giving a rate of 4.1:1000
  • 7% of stillbirths occurred at ³ 37 weeks gestation and 55% of those babies had a birthweight <10th centile.
  • 26% of the women who had a stillbirth were smoking at booking
  • 6% had a BMI ³ 30.

As a result of this comprehensive work, a regional multi-disciplinary review panel has been established to both test the review process as well as utilise the recently developed Perinatal Mortality Review Tool, developed by Wessex.


GP Psychiatry Study Day – Thames Valley

Following a request from CCGs in the Thames Valley, the TV Mental Health network has set up a series of Psychiatry study sessions for GPs across the patch. These are being run in conjunction with the University of Oxford and have been chaired by Professor John Geddes, Head of the Department of Psychiatry at the University.  Three events have already been run since December (two in Oxford and one in Reading) and four further events are planned for the year in High Wycombe (4 July) , Maidenhead, (26 Sept) Oxford (Oct) and Reading (Dec). These events have been very popular with over 250 GPs attending to date. Evaluations have shown that the GPs have found them useful and plan to change practice as a result of the presentations.

The agendas have been developed with input from GPs and from the clinical leads at the CCGs.
We have included skills training and ensured the areas of focus from the Mental Health Five Year Forward view are covered.  After the events all presentations have been uploaded to the SCN website so that the learning can be extended to a wider audience.  They can be found at:

http://tvscn.nhs.uk/mental-health-primary-care/psychiatry-for-general-practitioners-study-days/


Medical Revalidation – Annual Organisational Audit (AOA)

The AOA is designed to assist NHS England regional teams to assure the appropriate higher level responsible officers that designated bodies have a robust consistent approach to revalidation in place, through assessment of their organisational system and processes in place for undertaking medical revalidation.

The aims of the annual organisational audit exercise are to:

  • gain an understanding of the progress that organisations have made during 2017/18;
  • provide a tool that helps responsible officers assure themselves and their boards/management bodies that the systems underpinning the recommendations they make to the General Medical Council (GMC) on doctors’ fitness to practise, the arrangements for medical appraisal and responding to concerns are in place, and;
  • provide a mechanism for assuring NHS England and the GMC that systems for evaluating doctors’ fitness to practice are in place, functioning, effective and consistent.

During 2017/18 the Thames Valley team have been in contact with all our GPs with a prescribed connection. The figures in the Thames Valley demonstrate we have a high level of engagement from our GPs, with only 11 having not met the requirements for appraisal. Of the 11 with an unapproved missed appraisal, each has a plan in place for fulfilling the requirements over the coming months. If the team had not undertaken the task of moving all performers with appraisal scheduled in March to April, our percentages would have remained equal to last year.

 

Categories 16/17 Figures 16/17 Percentages 17/18 Figures 17/18 Percentages
Completed appraisals 1739 92.2% 1651 86%
Approved missed appraisal 137 7.2% 139 7.2%
Approved missed appraisal (moved from March to April administrative reason) 0 0% 120 6.2%
Unapproved missed appraisal 11 0.6% 11 0.6%
Total doctors on RMS & GMC Connect 1887 100% 1921 100%

 


ReSPECT – enabling choice, control and conversations in a future emergency

The ReSPECT process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices, intending to respect both patient preferences and clinical judgement. This informed approach should aid urgent and emergency care systems  to make the right treatment options For more information visit the website https://www.respectprocess.org.uk/

The work of the End of Life network in Thames Valley aims to support organisations and facilitate ways to enable ReSPECT to become an approach offered to all people in Thames Valley. A number of local and regional events are taking place to implement this in the region. In conjunction with the Wessex SCN, KSS ASHN and South West SCN End of Life Networks, they held a wider Frailty the Forgotten Voice in End of Life Care which also focused on the ceilings of treatment and how the impact of earlier decision-making and personalised conversations can provide good quality care.


Enhancing patient experience by bringing care closer to home – Cancer services in Wiltshire

In alignment with national ambitions to “Achieve World Class Cancer Outcomes”, the Thames Valley Cancer Alliance aims to improve patient experience by delivering care closer to home for patients with a head and neck cancer in Swindon.  At present, they receive their diagnosis at Great Western Hospitals, at which point they are referred to Oxford University Hospitals for treatment, rehabilitation and ongoing follow-up for an average of 5 years, and up to 24 clinic treatments. The impact of the 4-6 hour return journeys over a long period of time takes a toll on patients, their families and carers. One patient said:

“I didn’t feel well enough and felt weak for at least 9 months post-treatment…I had to rely on friends. My family worked full-time and had young families to look after so they found it difficult to support me in attending hospital appointments. I was lucky that most of my friends are retired and have the time to support me in coming to Oxford. If my friends were younger and in full time work this would have been more difficult”

As such I am pleased to report that the Thames Valley Cancer Alliance’s project to deliver care closer to home for residents in Swindon with Head and Neck Cancer are progressing well. A new multidisciplinary team comprised of: dieticians, speech and language therapists, clinical nurse specialists, restorative dentists, psychologists, and ear, nose and throat consultants will provide a holistic follow-up service for residents with a head and neck cancer at Great Western Hospitals.  The service is on-track to open in September.


Dementia – works across Hampshire, Isle of Wight and Thames Valley

Work continues across the region with leadership capability playing a key role. In the Thames Valley following the continued leadership support of “Dementia Friendly Practices” it is pleasing to see increased diagnosis rates from participating practices with learning and specific process support to improve diagnosis soon to be shared across the patch.

Wessex Clinical Networks, through their Dementia Pathway Redesign Programme led by the Clinical Network has resulted in the development and implementation of the Wessex Dementia Diagnosis Toolkit. The programme has demonstrated that it is possible to undertake a primary care diagnosis of dementias for those in residential settings. Furthermore it has demonstrated that having a diagnosis is of value to care givers and families and leads to improved post diagnostic care.

A series of short videos has been produced showcasing the involvement of the Clinical Network , a local GP and a care home manager and the impact they have seen using the Dementia Diagnosis toolkit.


Change Conversations Skills Masterclass

Wessex Clinical Networks and education provider, Difficult Conversations produced and delivered a GP-led programme of half-day communication skills masterclass workshops across Hampshire and Dorset. Over 100 health care professionals attended, 70 per cent of whom were GPs. The aim of the workshops was to build confidence and knowledge to have effective conversations with patients to make lifestyle changes. Evaluation responses by delegates revealed that:95% felt they had increased knowledge about communication skills to empower lifestyle changing behaviours.

  • 96% felt confident or very confident in using communication to empower change.
  • 100% of respondents stated it was highly likely or somewhat likely to improve their practice.

Comments from clinicians

  • “Really tested my thinking how to talk to patients.”
  • “Really enjoyed it, gave me good ideas to change my consultation approach.”
  • “Need to get all healthcare professionals to do this.”
  • “Brilliant workshop. Have learnt great tools to use, looking forward to putting it into practice.”

Creating a BUZZ about behaviour change

Wessex Activation & Self-Management Programme (WASP) carried out a regional evaluation of current supported self-management practice in relation to diabetes. A self-assessment tool was developed with aim of testing whether diabetes care is an activated system. It is important that we understand:

  • Are we as clinicians consistently implementing best practice?
  • Are we as managers & organisations supporting and equipping teams to deliver supported self-management?
  • Are we as commissioners supporting collective system development and implementation of best practice?
  • Are patients receiving good supported self-management practice?

41 frontline staff and 25 managers, of whom 10 were from CCGs, completed the self-assessment tool. Findings across the system showed:

  • There is evidence of awareness and knowledge of supported self-management and those who know about it believe it is a good thing.
  • Clinicians think they do it, but patients tell us a different story – 71% of clinicians say they ask the patient what they would like to achieve and follow their agenda. 37% patients report this experience.
  • There are tools but they are not always available – service managers wanted more knowledge about training available.
  • The system is not well co-ordinated – need a formal training strategy and wider organisational buy-in.
  • We don’t measure the impact of support well or consistently – CCGs felt strategy at STP level would be a good motivator but there are competing demands on commissioning levers.

Next steps for the programme:

  • Refine the self-assessment tool.
  • Support more pioneer project sites.
  • Achieve greater uptake of Patient Activation Measure tool.