Delivering 18 week pathways for patients Developing Good Practice Pathways

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Delivering 18 week pathways for patients
Developing Good Practice Pathways

• Jenny Bareham
• Head of Service Transformation
• Dr Steve Laitner
• Clinical Advisor -18 Week Pathways (GP Public
  Health Consultant)

January 2007 Version 1.0
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Development and Adoption of Good Practice

• Maximum Impact Shorter Pathways
• Efficiency and productivity
• Implementing what we know
• Development of transformational pathways
• Process
• Clinical pathways
• Template
• Involvement

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Drive efficiency and quality in current processes
and models of care
Delivery of 18 weeks
Challenge current models of practice to develop
transformational change
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Development of Good Practice Pathways
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Development of Good Practice Pathways

• Development of 3 symptom based (where possible)
  good practice pathways for the highest volume 12
  specialties
• To
• Challenge existing practice
• Utilise service improvement tools and techniques
• Maximise opportunities for transformational
  change
• Support commissioners to deliver 18 weeks
• To commence publication January 07

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Principles

• Clinically driven pathways that commence at the
  patients presentation of symptoms and end at
  completion of the patients journey i.e. should
  not end on the point of first definitive
  treatment and clock stops for 18 weeks.
• Pathways must not be defined by whether they are
  delivered in primary or secondary care. Elements
  of the patients pathway must be defined by the
  individual they are required to see and the
  equipment required NOT whether it is primary or
  secondary care provided.
• Be patient focussed e.g. reflect the patients
  view of when the pathway starts and finishes

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Principles

• Identify areas of clock stop and clock start
  within scope of the principles and definitions
• Draw on the learning from a range of
  pilots/working groups covering 18 weeks issues
• Maximise opportunities for utilising service
  improvement to improve efficiency and
  productivity along the patient pathway
• Identify resource implications for adopting the
  pathway, including workforce and IT

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Pathway Development

• To aid delivery against timescales the content of
  the pathways have been split into 2 phases
• Outlining the service modelto support
  commissioners in commencing local discussions on
  service models
• Completing the remainder of the template,
  including greater detail incorporating Health
  Care Needs Assessment, Public Health
  Interventions, Activity Data, Quality of Life
  Assessment and Outcome Audit, greater information
  on Workforce.

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Publication of Pathways

• 10 to be published on the Internet end January 07
  
• Refreshed with further information end March 07
  following feedback

Remainder of pathways to be published on the
Internet end February, and refreshed end April.
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Progress to date

• Identified clinical leads (consultant, GP) for
  each specialty to form a Clinical Advisory Group
• Identified and agreed symptom based pathways to
  work on
• Agreed generic template
• Working with clinical leads, AHPs, scientists,
  and other clinical colleagues to develop good
  practice pathways
• Collating good practice from national projects,
  local good practice, clinical guidelines

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Clinical Advisory Group - ToR

• The aim of the 18 Weeks Clinical Advisory Group
  will be to provide a forum for dialogue between
  the 18 Weeks Programme team and its wider
  stakeholders, particularly NHS colleagues. The
  membership will reflect the top specialties
  identified as high volume through our 18 weeks
  analysis.
• To begin with the Group will meet every six weeks
  and specialty teams will be tasked with actions
  in between meetings. Group members can also use
  the Group as a discussion forum for relevant
  issues.
• The focus of the Group will be on testing service
  transformation ideas and solutions that will
  include work on model care pathways and reviewing
  workforce needs across the service in light of 18
  weeks.
• Members of the Group will be asked to take the
  lead on identifying and further developing the
  top three model pathways within their speciality.
• Members of the Group will also act as an
  editorial board to validate any additional
  guidance around the definitions of 18 Weeks.

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Progress to date

• Identified clinical leads (consultant, GP) for
  each specialty to form a Clinical Advisory Group,
  supported by a project lead
• Identified and agreed symptom based pathways to
  work on
• Agreed generic template
• Collating good practice from national projects,
  local good practice, clinical guidelines
• Working with clinical leads, AHPs, scientists,
  and other clinical colleagues to develop good
  practice pathways to populate the template

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Developing Good Practice
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18 Week Patient Pathway Template Tier 1
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Summary Points from Pathways (1)

• Impressive clinical engagement and enthusiasm
• Encouraging clinicians to focus on thresholds for
  clinical assessment, diagnostics, interventions
  and referral
• DRE and PSA for LUTS
• X-ray for knee pain
• Endoscopy for dyspepsia
• Tonsillectomy for recurrent sore throat

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Summary Points from Pathways (2)

• Importance of self care and self assessment
  (supported and unsupported) to manage demand at
  beginning of pathway
• Importance of robust primary care assessment -
  red flags, diagnostic tests, diagnosis, remote
  specialist advice/ referral when necessary

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Summary Points from Pathways (3)

• Highlight the mechanisms to manage demand for
  interventions of limited clinical effectiveness
  such as varicose vein surgery, tonsillectomy
• Importance of patient/ carer information to guide
  informed decision making

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Summary Points from Pathways (4)

• Clearly demonstrating the number of Tiers
  required for each pathway suggesting radical
  changes in
• Direct access to diagnostics from primary care
  (e.g. Back MRI, helicobacter testing)
• Direct listing for surgery from tier 1 - e.g
  cataract from optometry assessment, vasectomy
  from primary care assessment,
• Direct listing for surgery from 1st specialist
  assessment including CATS/ interface
  service)
  

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Summary Points from Pathways (5)

• Driving efficiency
• day case operating,
• numbers of cases per list,
• all day operating lists e.g. Cataract,
• pre-operative assessment

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Final Summary Points from Pathways

• Assessment Alternatives
• Support for self assessment
• Support for self care
• Primary care providers e.g. Optometry
• Diagnostic alternatives
• Helicobacter testing instead of endoscopy
• MRI instead of arthroscopy
• Treatment alternatives
• Primary Prevention (Public Health Interventions)
• Mirena coil for menorrhagia,
• Physiotherapy, weight loss, joint injections for
  knee pain
• Medication for LUTS

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Sign off

• Process for gaining sign off within organisations
  (end January publication
• CAG 24th Sign off
• Feedback from Stakeholders
• Consensus events (March and April)
• Revised pathways before final publication
• ½ day per specialty (clinicians, managers,
  patient representatives)
• 1 day for wider engagement (Map of
  Medicine,e-care pathways, Institute, Improvement
  Foundation etc)

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Where to find out more

• www.18weeks.nhs.uk/servicetransformation
• Jenny Bareham
• Head of Service Transformation
• Jenny.bareham_at_dh.gsi.gov.uk
• 020 7633 4012
• Steve Laitner
• Clinical Advisor -18 Week Pathways (GP Public
  Health Consultant)
• slaitner_at_ntlworld.com
• 07771 625205