Throughout this newsletter, there are recurring themes of leadership development, quality improvement and integration. Clearly we all recognise that these are important areas. As well as the national drive by Public Health England to reduce premature mortality we are also doing our own local work on that front.
DR SHAHED AHMAD
NHSE ENGLAND (SOUTH CENTRAL)
I am delighted to welcome Jill Crook and Lisa Beaumont, who have been appointed as Directors of Nursing for NHS England South West (North) and NHS England Hampshire and Thames Valley areas respectively. It has been a real pleasure working with Jan Fowler and Ruth Williams and I will miss them both enormously.
Congratulations to the East Berkshire system who together have reduced their hypertension prevalence gap by 6,000 over the past six months, a significant achievement. Additional successes in the East Berkshire area include:
The change has been an excellent multidisciplinary team effort, and the team are happy to share their journey and lessons learnt with those looking to make improvements in similar areas. Please contact Sangeeta Saran if you want to know more.
Dr Anant Sachdev, Executive Partner at Ringmead Medical Practice, Bracknell, has shared the steps that the practice has undertaken to detect and treat hypertension.
The success of any team relies on effective team working, practicing safe and evidence-based medicine, employing good use of IT and agreeing on a ‘Shared Vision’ and ‘Measures’ to motivate and treat the patient. To achieve success in diagnosing and managing hypertension effectively, they have adopted the following approach:
|1. Use every method to diagnose or monitor hypertension:|
|Waiting room BP machine|
|Check blood pressure opportunistically when patients attend for:
i. Long term conditions review
ii. For any other reason
|Work with nurses, practice pharmacists, prescribing practice team|
|2. Check that the measurement is correct, by:|
|Action protocol for reception staff to follow with checks done in waiting room|
|Enlist the help of a 24 hour blood pressure monitor when results are unclear|
|Carry out medication reviews and stop drugs that raise blood pressure, e.g. NSAID, contraceptives|
|3. After diagnosis:|
|Explain hypertension complications repeatedly|
|Once started, explain side effects to avoid stopping treatments|
|Check compliance, establish concordance, encourage patients to self-check|
|Run regular reports to identify those overdue checks or have uncontrolled hypertension|
|4. Encourage positive lifestyle measures with advice at every contact:|
|5. Follow NICE/BHS guidance:|
|Maximise therapy aggressively using algorithms|
|Review 1-3 monthly until controlled, then 6 monthly or annually|
The following is a useful link to the Cardiovascular Disease Prevention: Improving outcomes in primary care journal, which was published in February.
I attended the start of the Getting Serious about Cardiovascular Disease (CVD) Conference 2018 run by Public Health England (PHE). Duncan Selbie, the Chief Executive of PHE opened the conference and gave a strong personal endorsement to the CVD prevention agenda. He was followed by Kevin Fenton, the Director of Public Health for Southwark Council. Kevin gave an outline of work his team was doing on CVD prevention, both from a health improvement perspective, but also from health intelligence perspective which was insightful. The report of the day and a link to a video of Kevin speaking can be found here http://bit.ly/2FyyDtS
Unfortunately I had to leave for Reading, before our own Raj Thakkar’s presentation Atrial Fibrillation. Having heard Raj speak at our Thames Valley CVD event , I’m sure he did us proud. The slides from our Thames Valley conference are available on https://tvscn.nhs.uk/wider-medical-directorate-communications/cvd-prevention-programme/
For colleagues who haven’t had a chance to view these slides, I think they’re fantastic.
Locally, it’s been a real pleasure to link in the products of the London Hypertension Leadership Group with the South Public Health England team. I’d really like to thank Jenny Harries, James Mapstone and other colleagues in PHE for their professionalism and passion in driving forwards the CVD agenda in the South. They have clearly articulated to the system the value in preventing CVD both in health and financial terms, especially through secondary prevention. They presented their programme briefing at the third meeting of the South CVD prevention board in March. Click here to read the programme briefing.
We ran a very successful recruitment campaign for new GP Appraisers in February/March. Over seventy applications were received from a wide range of doctors: salaried GPs, GP partners, and locum GPs of all ages. We were delighted to have such a positive response to our advertisement. After formal interviews, we have recruited 19 high calibre candidates who will now go on to participate in a national programme of training delivered by a team of our senior appraisers. At a time of intense pressure on the medical profession, there is greater need now more than ever for skilled appraisers who can provide professional support and guidance to our doctors. We are in the second cycle of medical revalidation and research has shown that the appraisal process provides an opportunity to record and discuss how each of us is delivering and improving care for our patients.
Despite the weather, a good number of our GPs made it to the South Central Leadership Forum. Topics discussed included ambulance service strategy, working with partners and an enlightening presentation from one of our CCG diabetes leads on how our leads are working together to further strengthen their impact.
We are already working on items for our future South Central Leadership Forum meetings and have secured a contribution from Sasha Karakusevic from the NHS Horizons team who recently, with Helen Bevan, facilitated a development day for Robert Varnam, Head of General Practice Development, NHS England, about developing primary care leaders of the future. The event used novel approaches which Sasha has kindly agreed to share with us.
Peter Bibawy and Adrian Hayter kindly invited me to the launch of cohort 2 of the Frimley STP 2020 Leadership Programme. The programme is a reflection of partnership working in action, designed and developed with STP partners and the Thames Valley and Wessex Leadership Academy. One of the strengths of the programme is that delegates come from all parts of the health and care system.
The course has been superbly designed, is well implemented and I am delighted that people from different institutions and different professions are learning together. Cohort 2 has over 30 fellows and heavily oversubscribed. In her presentation to the group, Maggie MacIsaac congratulated the successful applicants on having secured a place in a heavily competitive field. As part of the programme the participants are encouraged to carry out a change challenge; a quality improvement idea that links to the challenges within the Frimley STP. Some case studies from previous participants are included below:
The latest NHS leadership framework, Developing People Improving Care, includes quality improvement as a key element of leadership. It was good to hear from Stuart Bell that Oxford Health are in the process establishing an improvement hub. Click here to see the framework
Oxford AHSN have launched Life QI, which is available to all and includes everything you need to run your Quality Improvement project, in one place. The Oxford Patient Safety Collaborative is funding access for individuals and teams working on improvement in healthcare in the Oxford AHSN region, to access the LIFE QI system.
Using the LIFE QI system individuals and teams can create Driver Diagrams, conduct PDSA cycles, and visualise the results on SPC charts. Model for improvement tools are integrated to provide a platform tailored to running quality improvement projects.
Life QI is also designed to support open collaboration across organisational boundaries. It facilitates communication and sharing amongst project teams, and makes aggregating and reporting results simple. You can find more information on Life QI here.
The Buckinghamshire, Oxfordshire and Berkshire West (BOB) STP and Buckinghamshire Integrated Care System (ICS) have been delivering the NHS Improvement (NHSI) Quality, Service Improvement and Redesign (QSIR) programme across the footprint since 2016. The teaching associate team consists of colleagues from Buckinghamshire County Council, Oxfordshire University Hospitals NHS Foundation Trust, NHS Oxfordshire and Buckinghamshire CCGs and expands this year to include Buckinghamshire Healthcare Trust.
In the first year they have delivered the NHSI programme to over 150 participants and support a wide range of projects e.g.
Initially funded by Health Education England, they also received In Place Leadership Innovation Funding for implementing a local quality improvement methodology. The aim of this is to increase the availability, scale and reach of high quality, high impact, leadership opportunities by demonstrating the support of the leadership behaviours required to effectively implement the ambitions of the Five Year Forward View and development of STPs and ICSs.
The unique make-up of the BOB STP/Bucks ICS team ensures that they have a diverse cross-section of feedback on the content of the QSIR programmes and as a result they are:
For more information, follow the links below:
In discussion with our CCG chairs, they have highlighted the importance of supporting CCG clinical leads leadership development. The Thames Valley SCN has subsequently facilitated a session for the CCG diabetes leads and one for the CVD leads.
In late February, I met Steve Powis, the new NHS England National Medical Director, with my NHS England Medical Director colleagues from across the country. Steve outlined his priorities as:
When the cold snap hit us in late February, we worked with the communications team to make sure that we put out the right messages to help people stay well and I know many others took a similar proactive approach:
Bath Echo article: http://bit.ly/2Iaq5b0
Cherwell Valley Gazette article: http://bit.ly/2HeRs2q
On behalf of NHSE, I’d like to extend our thanks to all our staff who went the extra mile to make sure patients were seen and looked after.
Maggie MacIsaac updated NHS England colleagues on the North East Hampshire and Farnham Vanguard, “Healthy Happy at Home”. The slides are really informative and clear and can be viewed here.
Professor John Middleton, the President of the Faculty of Public Health, suggested I meet with Emily Dobell, who was the representative of the Oxford Public Health Registrars. Emily briefed me about the work of the registrars. Thames Valley Public Health Registrars have been working with colleagues on a number of projects in healthcare public health.
At Milton Keynes Hospital work has included writing and implementing a prevention plan for the hospital, working towards improvements in staff wellbeing and morale in A&E, and measures to reduce E.coli blood stream infections. Additional work with the CCG has included reviewing A&E attendances (in view of recent data and an A&E patient survey) as well as supporting the NHS England diabetes transformation fund bid.
At Oxford University Hospitals, a new project is underway to achieve the Risky Behaviours CQUIN which focuses on identification and brief advice for alcohol and tobacco use amongst the 60,000 inpatient admissions the NHS trust sees each year. This includes integration with community alcohol and smoking cessation services to ensure a cohesive pathway for patients. Public Health Registrars have also worked alongside colleagues in the health promotion clinic ‘Here for Health’ and the Occupational Health and Wellbeing department, to improve the food environment by encouraging retailers to supply healthier options as part of the NHS Staff Health and Wellbeing CQUIN.
Meanwhile in Buckinghamshire, a Public Health Registrar has been leading the development of population health management in liaison with CCG and NHSE colleagues, as part of the Integrated Care System pilots. This uses risk stratification to identify individuals most likely to benefit from services and will support service planning by modelling and mapping existing services against needs.
The Thames Valley Strategic Clinical Network (SCN) held its population health event in late February. I’m delighted that so many colleagues from across South Central joined us. You can view the presentations from the day here. Julian Brookes the Deputy Chief Operating Officer from Public Health England set the scene. He dispelled the myth that public health interventions have no short term return citing the example of the smoking ban in Scotland. He also gave examples of public health interventions which can be shown to have a financial return on investment and highlighted PHE’s six interventions from its menu of interventions which could save over £400million over 5 years. Dr Shakiba Habibula described the work Buckinghamshire are doing on population health management and John Lisle and Mark Sellman described the Berkshire Connected Health programme. Unfortunately extreme weather conditions meant that Dr Abraham George wasn’t able to reach us from Kent, but we were able to get a taster of his presentation via webex, which can be found here.
Across the South, NHS England and NHS Improvement have been looking at how we might work together in a more streamlined way. One area where we have already begun to make improvements is the joint systems assurance meetings with our emerging Integrated Care Systems. Having a single conversation is certainly a much more efficient way of conducting assurance and development meetings.
Good cancer care begins with good pathways. The NICE guidelines (NG12 2015) were developed to improve referral rates and referral content.
In Oxford, after their publication, two week wait referral forms were made mandatory and they included educational points to help GPs decide who and when to refer. In collaboration with secondary care specialties the criteria for NG12 was adapted to fit the local services and allow ‘right slot, first time’ to be attained.
By studying the complete pathways where targets are often missed (urology, gastrointestinal, gynaecological and lung) Oxford have been able to move some of the diagnostics ahead of first outpatient appointment to achieve a more streamlined course of care and better outcomes.
By working together across primary and secondary care on the four pathways where performance is currently is problematic, the new Cancer Alliance pathways workstream hopes to achieve a more effective outcome for patients across the entire Thames Valley, even when the test result is negative. By referring early into an efficient pathway and reducing the gatekeeper function, it is hoped to reduce the cancer pick up rate to 3% and detect cancers earlier with all the benefits that these sequelae allow.
The South of England Cancer Alliances Dashboard (version 2.5) is now available on the TVSCN website here.
Colleagues will remember that Dominique Allwood came to present about Q at the South Central Medical Directorate Conference last June. Applications to join Q will open in the summer. Click here for more details.
Colleagues will recall that in the last issue I mentioned the musculoskeletal workshop held in Reading. Oxford’s AHSN has since compiled a new guide which showcases programmes being delivered by AHSNs to improve clinical services in the areas of musculoskeletal disease, falls, fractures and frailty. You can download the guide here.
The rollout of our Primary Care Improvement Connect space continues. This new online space supports all who are involved in any element of the Time for Care programme. You can use it to discuss, share, learn, download resources and find out more about forthcoming events.
Click here for instructions on how to join.