Shared learning database

Type and Title of Submission


Pathway to recovery: Development and recovery of a person centered pathway of care for psychosis


Tees, Esk & Wear Valleys NHS Trust have developed a Psychosis pathway to support the implementation of NICE CG82 Schizophrenia; the evidence based pathway covers all clients with a diagnosis of psychosis within the communities of Tees, Esk and the Wear Valley. The concept of the Pathway is to understand and articulate the client journey, and the effective and efficient management of the systems, people and environment supporting that journey. It ensures there is a robust governance structure in place which facilitates the effective application and monitoring of the NICE guidance.

Please note that this example was originally submitted to demonstrate implementation of CG82 Schizophrenia (update). CG82 has now been replaced by CG178. The example has been reviewed and continues to align with the new guidance.



Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG178 - Psychosis and Schizophrenia in adults

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?


Description of submission


The aim of the pathway is to support all clients with a diagnosis of Psychosis, while embracing the wider issues of a concurrent diagnosis of anxiety or substance misuse, etc. It provides a tiered model of service provision, with the recovery pathway following a 24 month timescale. It encompasses this as a cyclical process, meaning that clients can be supported over more than one 24 month cycle if required. Other associated clinical pathways will be used in conjunction with the main psychosis pathway (e.g. a Person Centred Pathway has been developed for the commencement and management of Clozapine). The application of the pathway will eliminate the issues arising from potential inconsistencies in clinical practice.


1. To develop a person centred pathway which will ensure evidence based care is delivered in a standardised and replicable format, complying with NICE Guidance. 2. To ensure clients receive care and support of an equitable standard regardless of their geographical location across the communities of Tees, Esk and Wear Valley 3. To provide an effective tool to audit compliance with NICE Guidelines ensuring that clinical outcomes are effectively monitored within the organisation and externally benchmarked where possible.


Tees, Esk and Wear Valleys NHS Foundation Trust cover a large geographical area which encompasses both urban and rural communities. Prior to the development and implementation of the pathway, care delivery for the client group with psychosis symptoms was inconsistent and difficult to monitor. The organisation is committed to implementing and monitoring NICE guidance to ensure consistent delivery of high quality clinical care and treatment to all patients. In addition, it was acknowledged that development of a Psychosis pathway would also prepare the organisation for other planned changes such as the introduction of payment by results to mental health. A multi professional group within the organisation led by a Consultant Psychiatrist/Associate Clinical Director Adult Services and a Nurse Consultant has driven the development of the Psychosis Pathway. As part of a baseline assessment a large consultation event was held to look at the main themes and issues to be addressed and included within the pathway. This event was attended by staff groups, clients, carers and advocacy and support groups. The outcome of the event was very positive and formed the basis of the work to be undertaken, but most importantly highlighted the need for a recovery model to be adopted.


1. A clearly defined pathway for the management of the client journey across all disciplines was developed, piloted and is in the process of being implemented across the organisation. 2. In accordance with NICE Guidelines a supporting pathway for the management of those clients treated with Clozapine was developed. This document is designed to be used simultaneously with the main Psychosis Pathway as a 'clip' to ensure equitable care across the Trust 3. The application of the Pathway has allowed clients and carers to be fully aware of their care delivery, and promote recovery and partnership.

Results and evaluation

The pathway has been presented in its pilot format to the European Annual Integrated Pathways Conference in June 2008. At the time of writing final data from pilot sites is still being collated for statistical analysis. Earlier variance analysis undertaken at key evaluation stages during the pilot identified some common themes, which have led to the further development of the pathway. These included clarification of core assessment tools, inclusion of information prescriptions and identification of further staff training. Informal feedback from clients on the pathway has also been positive. A staff evaluation was undertaken as part of the pilot, which illustrated that staff felt aware of the project, and that they felt their input was valued in the design of the paperwork and tools. Staff also identified that they felt supported on delivery of the Pathway, and that there was clearly identified and accessible support with queries or problems. Further work needs to be undertaken with regard to the monitoring of clinical outcomes. This will be addressed as part of the full implementation stage.

Key learning points

Ongoing discussion with clients and their carers regarding the core components of the pathway is essential. When asking their view point it is then important to feedback what action you have taken as a result of their comments. Involvement of staff at grass roots level in developing the pathway as a viable and appropriate tool was vital. Ensuring that staff are appropriately trained prior to the pilot or full implementation stage is a wise investment for the sustainability of the pathway. However, effective engagement of the cynics is a challenge and should always be positively addressed. Linking the pathway development to the organisations strategy for the implementation and monitoring of NICE guidance is crucial. Support from the Clinical Effectiveness Team to audit and analyse the variance data from the pathway was fundamental to timely information being reported to clinical teams. Patient centred care pathways do enhance clinical decision making and improve outcomes for the client.

View the supporting material

Contact Details

Name:Pauline Craig
Job Title:Senior Manager: Service Development
Organisation:Tees, Esk & Wear Valleys NHS Trust
Address:Lancaster House
Postcode:TS18 3TS
Phone:01642 853542


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This page was last updated: 30 September 2009

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.