TVSCN > Medical Director Update – Hampshire/IOW/Thames Valley Q2 2018/19

Medical Director Update – Hampshire/IOW/Thames Valley Q2 2018/19

Dear colleagues,

It has been one of the busiest second quarters I can remember. An incredible amount has happened, and this is a real testament to the hard work of everybody in the system. A significant amount of this work has been to support the clinical leaders in our system. The flagship programme is our NHS@2030 programme, which is supporting 85 professionals develop and strengthen their leadership skills. We were privileged to be joined by Matthew Cripps during our 18 September meeting, who shared his expertise in making improvement happen at scale, and by Jonathon Sergeant who helped us all remember that the skill of listening is the most important leadership skill for making change happen. It was also a pleasure to meet new colleagues from Hampshire and the Isle of Wight who have joined this journey and are sharing ideas with the rest of the group. I am particularly impressed by the activity on the 2030 WhatsApp group where its members share information and advice at a phenomenal rate. Of course the NHS@2030 programme would never have happened had the South Central Leadership Forum not coalesced as a group and its members requesting a leadership programme for a broader range of primary care leaders. I am truly indebted to the South Central Leadership Forum for giving us the advice and mandate to develop NHS@2030.

Public Health England (PHE) launched a heart age campaign and it has been pleasing to see our local health systems promote it. PHE held their annual conference in September; amongst the highlights for me were an excellent session on controlling outbreaks globally, a session on early diagnosis of cancer, one on rural public health, and a session on digital marketing. You can find the presentations here.

Early in this quarter we received feedback about the Medical Directorate Conference held in June, which was overwhelmingly positive. We had great speakers, both internal and external. The conference gave over 100 colleagues the opportunity to connect with others, and it continued to enhance our improvement capability. For those who weren’t able to make the conference, the slides are here.

Colleagues will also remember that we ran a conference on population health in February. It’s pleasing to see just how much support there is for progressing that agenda. NHS England is running a series of workshops across the South of England and I do hope that there will be a good range of clinicians participating and making sure our thinking is clinically informed. It was good to see Chris Bentley who once led the National Support Team for Health Inequalities give a presentation recently on the topic of health inequalities.

I took over NHS England Medical Director responsibilities for Hampshire and the Isle of Wight in addition to the Thames Valley on 1 July. Since then I have been speaking to and meeting CCG Chairs, Accountable Officers, and NHS Trust Medical Directors in Hampshire and the Isle of Wight. It was a pleasure to be invited to the Hampshire Isle of Wight STP leaders meeting in Southampton. The level of attendance and engagement of leaders from across the system, from both the NHS and local government (officers and elected members) was a pleasure to witness.

Within the team, we have been making efforts to support colleagues in Thames Valley and Hampshire to get to know one another and provide each other with peer support. Regionally and nationally colleagues have been looking at how NHSE and NHSI can work more closely together, how to best support Integrated Care Systems, and much work is going on to develop the long term plan. Colleagues can find out more by looking at the papers which went to the NHS England and NHS Improvement Board meetings.

On a more local level, I have been working with Dr Lalitha Iyer, Medical Director of East Berkshire CCG to explore how we can best support CCG clinical leads in her patch. In this newsletter we describe a learning set that our diabetes clinical leads have been participating in to improve outcomes, and it’s really pleasing to see that it is really delivering. In designing the future support for clinical leaders, we will be building on what we have already learnt.

Finally I’d like to congratulate our South Regional Medical Director, Nigel Acheson, who has taken up the role of Deputy Chief Inspector of Hospitals at the Care Quality Commission, focusing on London and the South. Over the years we have all benefitted enormously from Nigel’s fantastic leadership skills and ability to build coalitions. We thank him for providing us with highly effective leadership, wish him all the best for the future, and look forward to working with him in his new role.

DR SHAHED AHMAD
MEDICAL DIRECTOR
NHS ENGLAND (HAMPSHIRE/THAMES VALLEY)

National CVD Prevention System Leadership Forum

In mid-September I attended the third meeting of the National Cardiovascular Disease Prevention System Leadership Forum (CVDSLF). The meeting brings together partners from over 30 organisations, including NHS England, arm’s length bodies, government, the third sector, royal colleges, clinicians and academia. Convened by Public Health England, the CVDSLF is responsible for the collective programme of work on CVD prevention, with a focus on the three major risk factors – blood pressure, atrial fibrillation (AF), and cholesterol.

Over the past three meetings, we have been collectively working to establish five year CVD ambitions for England to improve the detection and optimal management of blood pressure, AF, and high cholesterol. We are planning to publish these later this year, with the aim to show system leadership and galvanise local action. It has been confirmed that CVD will be highlighted as a clinical priority in the upcoming NHS Long Term Plan, and NHS England has been consulting with this group on its development. We have also discussed key topics, including the upcoming CVD return on investment tool and the 2019 CVD Prevention Conference.

British Heart Foundation House of Care animation and digital report

The British Heart Foundation Care and Support Planning project has come to an end, receiving good feedback from patients and healthcare professionals who have benefitted from the adoption of the House of Care model for people with cardiovascular disease. Steering group member Julia Coles (cardiovascular disease/long term conditions network manager) is continuing to work within the Thames Valley SCN to support the adoption of the approach across Thames Valley.

You can learn more about the project from this video or the project documentation.

Diabetes clinical leadership development

The Thames Valley Strategic Clinical Network, in conjunction with the leadership academy, have been running a learning set for the CCG diabetes clinical leads. Amar Latif, clinical lead for diabetes at Oxfordshire CCG said:

“These learning sets have proved invaluable for providing a space to allow deep discussions around common challenges faced across the Thames Valley area. We are all so busy ‘doing’ with meetings, emails, and project deadlines that it is rare we get a chance to stop and think. Through the learning sets I have been able to analyse how to approach clinical leadership in a more effective and efficient way. It is very useful to hear the perspective of other colleagues and how they may approach similar situations, which has already had an impact on my own personal clinical leadership.”

Oxfordshire treatment targets

Having bid successfully for diabetes transformation money and part-matched this funding, Oxfordshire CCG has made a significant investment of £1.5 million into care for patients with diabetes across Oxfordshire over the last two years. This has focused on three key areas:

  1. Expansion of structured patient education.
  2. Establishment of a daily multidisciplinary foot team.
  3. Improvement of the NICE triple treatment targets (blood pressure, cholesterol, and HbA1C).

This work has included diabetes multidisciplinary teams at every practice involving diabetes consultants and the diabetes specialist nursing team, both of which have proved universally popular and hugely useful for direct advice about patient care. The CCG has also had Locality Diabetes Review meetings, where GP and practice nurse leads across a locality have come together to share best practice and attempt to tackle common challenges. These meetings have proved very lively with lots of energy and ideas being shared across practices.

The CCG has also included an expansion of the diabetes specialist nursing team to support primary care; development of the diabetes dashboard which has proved useful in monitoring progress, highlighting areas for action; and securing funding for the Go Active Get Healthy exercise programme. They are in the process of putting in place locality diabetes co-ordinators, a network of GPs and practice nurses who support primary care to build and expand on the excellent work already happening.

Oxfordshire CCG is excited to announce the implementation of Year of Care to all practices, and has appointed new support workers who will be going into practices to help support the roll out.

Finally, they have also implemented Skype consultations, so that quick advice can be sought from consultants who can view the patient’s record via Skype, offer timely and accurate advice, and prevent unnecessary delay to patient care from a traditional referral.

The CCG has seen a huge network of diabetes specialists being developed and they are now eagerly awaiting the next National Diabetes Audit which is anticipated to show a significant improvement in the area’s achievement.

Oxfordshire diabetes dashboard

The National Diabetes Audit (NDA) currently reports annually and is moving to a quarterly report. This time lag was identified by Oxfordshire CCG as a key barrier to implementation and subsequent monitoring of effective change for patients with diabetes to have met the NICE recommended 8 care processes and triple treatment targets.

With the arrival of new software in the form of EMIS Enterprise (all but two practices in Oxfordshire are on EMIS) the CCG has been able to develop a unique Oxfordshire Diabetes Dashboard in conjunction with the local CSU team. This provides monthly reporting data to GP practices across Oxfordshire, in an easy-to-use format and allows clinicians to identify patients who require further input at a glance.

The data is also presented in a way which allows comparison against practices in the same locality, across the county, or compared to the England average.

This approach was robustly tested in one locality over nine months, where the CCG was able to demonstrate a 12% increase in achievement of the 8 care processes, and over a 1% increase in attainment of the triple target. It has now been rolled out across the whole county and it is hoped that similar results will be replicated. This is a good example of how new technology can help identify gaps in current provision and lead to an improvement in patient care.

Thames Valley SCN new CVD LTC clinical lead

The Thames Valley Strategic Clinical Network is pleased to announce the appointment of Raj Thakkar as clinical lead for the cardiovascular disease/long term conditions programme. Raj is currently Clinical Commissioning Director for Planned Care, and a GP in Buckinghamshire CCG. He will join the network in October, for two days a week. Initial areas of focus will be diabetes and CVD secondary prevention.

Leadership

South Central Leadership Forum update

The Clinical Leadership Forum was originally designed to give a space to clinical leaders from primary care to come together to hear from national and local speakers about key issues impacting on their services and to share ideas for local solutions. Building on success, the remit has been widened with trust medical directors now participating in the group and, as from July 2018, the geographical patch has been expanded to welcome clinical leaders from Hampshire and the Isle of Wight. The Forum in October will hear about developments in cancer. They will also hear from the Independent Reconfiguration Panel that looks at service change proposals which have come under scrutiny by the Secretary of State. They will be hearing about common mistakes and how to avoid them. The use of population health is growing rapidly with the first wave ICSs receiving specialist support to help develop its application, and the Forum will hear about how it is being applied locally.

NHS@2030 

We launched the NHS@2030 programme in July 2018 across South Central, and since then we have joined 85 clinical leaders to each other, to NHS Horizons, NHS RightCare, NHS Collaborate, and to their own values and reasons for wanting to improve health and healthcare. It is all about population healthcare improvement and our patients.

The 73 GPs, five primary care nurses, and seven NHSE senior managers and clinicians have access to coaching, 360 feedback, national experts and local networks. One participant said:

“A 2030 WhatsApp group keeps us in touch between sessions and with the evidence and research, the national policy and with each other’s local ideas. Splinter network groups are forming to work on local projects or wider clinical challenges such as CVD.”

Kiren Collinson, Clinical Chair of Oxfordshire CCG said:

“Often courses can be dry and impersonal – but the NHSE 2030 course feels different​. The speakers have been dynamic and inspiring and have shared valuable insights into real life success stories. Just as important are my fellow participants: Sharing experiences with GPs from different organisations, backgrounds, and counties has been enriching and reinforces that there is a lot to be said for ‘who you know’. I have enjoyed the course so far and look forward to the next instalment.”

The October event will support delegates to work on their chosen projects with practical support from national experts including those from RightCare, NHS Confederation, Public Health England, the National Association of Primary Care, and health charities.

Participants will then have the data, confidence, and competence to apply their learning to improve care locally. In November and December, through facilitated group work, they will start to put into practice what they have been learning about.

The programme has been so successful that we are already planning a second cohort running next year, for all people involved in leading in improvement health and social care in Thames Valley, Hampshire, and Isle of Wight. Other areas in the South West are also thinking of doing the same.

Keep an eye on the website for more information.

AHSN/HEE/TVSCN Learning Together publication

The Oxford Academic Health Science Network (AHSN), Health Education England (HEE), and the Thames Valley Strategic Clinical Network (TVSCN) have produced a brochure highlighting the collaborative work they have undertaken together, to better deliver health and social care in line with national and local priorities.

The publication, Learning Together, showcases projects like the perinatal mental health matrix, the rollout of PINCER (an audit tool to reduce prescription errors), and the delivery of mobile ECG units across the Oxford AHSN area.

You can download Learning Together here.

GP appraiser updates

The team are happy to announce the appointment of Dr Honor Merriman, to the role of interim Appraisal Lead. Dr Merriman will be supporting the team with all aspects of appraisal and revalidation in the Oxfordshire, Buckinghamshire, and Berkshire areas.

This is an interim role from now until the end of March 2019 and we are very pleased to be welcoming her into the team. We would like to take this opportunity to thank Dr Sue Frankland and Dr Sarah Morando for their unstinting support to the Revalidation and Appraisals Team. On behalf of everyone in the team we wish them all the very best for the future.

As we enter the first year of the second cycle of revalidation, the team are busy with the approval process. Last year the team approved 53 revalidations in the final year of the first cycle. This year has seen the team approve 248 people already, with a further 139 due before the end of the year.

Mental health

CLAHRC Oxford presents work to APPG on suicide and self-harm (February 2018)

Researchers from the National Institute for Health Researchers (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford were invited to present evidence to the suicide and self-harm All-party Parliamentary Group (APPG).

Professor Keith Hawton, from Oxford University’s Department of Psychiatry, presented his work looking at demographic trends and the costs of self-harm, as well as the findings of CLAHRC Oxford-supported work on the hospital costs of self-harm (click here to read the original study as published in The Lancet).

The study revealed that the average cost of each episode of self-harm was £809, and that costs were higher for adolescents than adults. The total hospital costs of self-harm to the NHS across England could amount to £162 million each year. The study emphasised the need for effective clinical services and prevention initiatives.

Prof Keith Hawton presented his work to the Thames Valley Clinical Senate (the Senate) in September identifying the link between self harm and suicide. The Senate is looking at current mental health services across BOB and Frimley STPs to assess to whether they give the system the best chance to reduce deaths by suicide.

Perinatal mental health matrix rollout and NICE endorsement


The Thames Valley Strategic Clinical Network has developed and implemented the perinatal mental health matrix, an online tool designed to audit perinatal mental health services against two NICE guidelines (CG192 and QS115). The guidelines identify areas where early care can be offered to improve womens’ experiences and outcomes, and whilst helpful, there was no standard method to measure service performance against these benchmarks.

Developed with NICE’s support, the matrix audits care provided by maternity, health visiting, and community perinatal metal health services. It also measures referrals to services, workforce staffing levels, and how well services meet the NICE quality standards. It has been rolled out across the South East and South West, and services have identified ways to improve quality of care, and ways to work together to improve outcomes. Clinicians have embraced opportunities to improve care for women using evidence-based practice, and the matrix has received an endorsement from NICE.

For more information on the matrix, please contact Sarah Fishburn (sarah.fishburn1@nhs.net, 07730 381189).

MBU WebBeds

MBU WebBeds is a new 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 phone calls about potential referrals even if their MBU was full. The new website, developed in Wessex, 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 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.

WebBeds Clinical Leads: Jenny Walsh, Clinical Lead for Perinatal Mental Health, Wessex Clinical Networks and Dr Giles Berrisford, Associate National Clinical Director for Perinatal Mental Health for NHS England

For further information, please contact: england.wessexscn@nhs.net

Wessex Dementia Diagnosis Toolkit

The Wessex Dementia Diagnosis Toolkit was developed by the Wessex Mental Health Clinical Network in conjunction with local stakeholders. Recently updated to reflect the updated NICE guidance, it is now available for download here.

It is suitable for use by patients and family, GPs, care home staff, and specialised memory clinicians. The impacts of use are shown below:

A series of short videos has also been produced to support the Toolkit:

Thames Valley Dementia Network 2018 achievements

The Thames Valley Dementia Network has had a productive year. The network’s key aims are:

  • To identify two-thirds of the predicted dementia population.
  • To ensure people receive an appropriate and timely diagnosis.
  • To ensure people with dementia have access to good quality, evidence-based support.

As well as publishing regular Dementia Matters newsletters, hosting the Living Well With Dementia conference, and co-ordinating the quarterly Dementia Commissioners Forum, the network has been involved in a wide range of activities:

  • Continued to support CCGs to deliver the 67% Dementia Diagnosis Rate (DDR). Collectively Thames Valley has achieved 66.46%, which is still slightly short of the national 67% target, but the plan is to meet this by the end of 2018.
  • Completed a successful project developing dementia clinical leadership and an exemplar dementia friendly GP practice in each of the Thames Valley CCGs. Read the project report here.
  • Commissioned a review of Dementia Advisors models across the region and developed recommendations for CCGs when commissioning a Dementia Advisory service. Read the review here.
  • Supported CCGs to deliver tier 1 & 2 dementia awareness training to primary care staff.
  • Developed TVSCN CCG and practice level dashboards to identify trends and areas for improvement in both dementia diagnosis rates and post-diagnostic care.
  • Scoped provision of post-diagnostic support services available for patients in Thames Valley.
  • Promoted and supported the diagnosis of patients in care homes using the Diadem tool.

Next year, the dementia network is looking to:

  • Exceed the DDR national target of 67%.
  • Support and embed dementia clinical leadership within CCGs.
  • Develop a ‘care and support planning toolkit’ to support a quality approach to a dementia annual review.
  • Develop a quality standard for dementia care in care homes to reduce unplanned admissions of patients in care homes across BOB STP.

The dementia network wishes to promote a system-wide approach to reduce the variation and support improvements in dementia care across the region.

Neurology Online platform for users of Wessex neurological services

As part of joint working between the Wessex CLAHRC and the Wessex Mental Health Network, patients and clinicians working in neurological services can now access an online platform.

The platform builds on the patient portal in use at the University Hospital Southampton My Medical Record and expands into Solent Trust community services. The platform allows service users and healthcare professionals to:

  • Share information via online access to their clinical letters and appointments.
  • Enhance self-management by jointly completing agreeing goals and care planning.
  • Improve communication through messaging in a safe and secure environment.
  • Promote and align to research studies to increase participation and provide best evidence for future changes in clinical care.

Cancer

Head and Neck Care Closer to Home pilot

Over 9,200 new cases of head and neck cancer are diagnosed each year in England. Head and neck cancer can have a devastating effect on patients as it can develop in particularly sensitive parts of the head, such as the mouth and throat. Patients need long-term support, rehabilitation, and access to a wide range of specialised care and staff.

The Head and Neck Care Closer to Home pilot is a result of a five year collaboration between CCGs, trusts, the Thames Valley Cancer Alliance, and Macmillan Cancer Support to improve patient experience and enable Swindon and Wiltshire head and neck cancer patients to receive care closer to home.

Until the pilot, patients in Swindon and Wiltshire were diagnosed at the Great Western Hospital, then referred to Oxford University Hospitals for treatment, rehab, and follow up. Patients and their families had to organise six one hour round trips over a number of years: the average follow up period for a head and neck cancer patient is five years.

A clinic has now opened up at the Great Western Hospital for the follow up rehabilitation of head and neck patients, which hosts weekly consultant-led clinics, a clinical nurse specialist, a speech and language therapist, a dietitian, and enhanced dentistry and psychology services. The new service will benefit 65 patients from Swindon and Wiltshire per year.