Implementing NICE Guidance in Hull and East Riding

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Implementing NICE Guidance in Hull and East Riding

• Dr Andrew Taylor Head of Public Health
  Sciences, PHDT
• Dr Louise Girardier Head of Clinical
  Effectiveness, HEYHT
• Mrs Jenny Walker Clinical Policy Support
  Manager, PHDT
• NICE Task Group of the Hull and East Riding
  Clinical Policy Forum

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NICE CONTROVERSY
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NICE and Clinical Excellence

• Welcome the move towards
• Consistent service provision
• Ending of postcode lottery
• Rational and critical assessment of evidence to
  give a scientifically based decision
• Potential for supporting modernisation
• In only 4 years NICE has developed a
  well-deserved reputation for innovation and
  methodological developments that represent an
  important model for technology appraisals
  internationally. World
  Health Organisation

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Background

• Clinical Policy Forum established 1999
• Covers Hull and East Riding of Yorkshire -
  Patch-wide
• Large geographical area 563,000 population
  inequalities
• 4 PCTs, 1 Mental Health Trust, 1 Hospitals Trust
• PEC Chairs (4 PCTs) Medical, Surgical and Nursing
  Directors, Pharmaceutical and Health Economics
  input
• NICE LICE Paper (Madhok Taylor)
• Emerging implementation system challenges
• Dedicated CPF Task Group established 2004
• Unique collaborative approach
• Now 8 months into 3 year project
• Substantial progress made in establishing systems
  and toolkits and implementation manual

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Clinical Policy Forum (CPF)
Prof Exec Committees
Chief Execs Forum
NICE Task Group
Area Prescribing Committee
Joint CPF LDP Board
Humber Mental Health Trust Clinical
Effectiveness
Hospitals Trust Clinical Effectiveness
4 PCT Clinical Effectiveness
Mental Health Trust Board
PCT Boards
Hospitals Trust Board
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Systems Toolkits

• Previous issues within Hospitals Trust
• Fragmented approach
• Lack of clarity
• Lack of sustained project management
• Project Plan (three phases)
• Accountability agreement ownership
• Clarity of purpose
• Organisational objectives
• Professional and managerial accountability

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NICE BCR Monitoring Project

• Comprehensive toolkit user manual
• Complete information and education provided at
  each stage.
• Service managers and clinical leads
• Clinical governance facilitators
• Clear objectives with defined timescale
• Planned review and reminder system
• Monitoring and Evaluation
• Compliance with the core standard statement
• Patient information needs/risks comp/leaflets
• Local guidelines and protocols
• Contribution to national databases or clinical
  trials
• Involvement in Audit

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BCR Compliance Reporting

• Reporting
• Accountable groups to Board Level
• Risk Management
• Clinical Audit
• Pharmacy
• NICE Task Group CPF and LDP
• Process and knowledge management
• Dedicated website

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Implementation Philosophy

• Clinical Governance systems
• Realistic and robust
• Knowing customers services
• Match clinical systems processes
• Theories of Change Management
• Accepting new systems processes
• Embed and strengthen in partnership
• Fostering ownership understanding
• Increasing tangible evidence of compliance

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Financial Issues

• Health Economics estimates of cost impacts of
  each technology appraisal within speedy overview
  of guidance
• Cost issues fed through CPF and into LDP process
• NICE seen as must do
• Flexible commissioning
• Moving to Payment by Results
• Patient pathway approach in development

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Gathering the Evidence

• Compliance rates BCRs
• Recording reporting compliance
• Full partial phased or non-compliance
• Partial compliance
• Minor moderate major
• Phase two
• Non-compliance letter templates
• Non-compliance implementation plans
• Actions plans
• Risk management
• LDP / commissioning
• Phase three
• Embedding systems and processes across all Trusts
• Incorporating NICE Guidelines within NSFs and
  other national imperatives
• Identifying committing resources and posts
• Sustaining strong partnerships through shared
  vision

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A Patch Wide View

• Backing of senior clinicians in Clinical Policy
  Forum
• Monthly NICE Task Group meetings
• Flexible iterative systems that work for each
  Trust
• Supportive, collaborative approach
• Central collation in patch-wide compliance
  spreadsheet
• Established route for problem solving via CPF if
  required

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Challenges

• Sustainability
• Extending process and embedding rigorous systems
  for implementation, monitoring audit of
  Clinical Guidelines
• Need for ring-fenced resources funding for
  implementation teams across whole system
• Uncertainty of organisational structures
• Independent contractor status of GPs
• Inequalities in prescribing? - Equity Audit

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In conclusion

• Hull East Riding Clinical Policy Forum
  demonstrates a unique approach
• N ovel and flexible systems
• I nnovative and integrated with clear leadership
• C linical and managerial accountability
• E ngagement from all local NHS Trusts