North East Lincolnshire Care Trust Plus was formed in September 2007, a unique development, being the first in the country, to bring together health and social care under one organisation and providing an integrated Public Health function by transferring it to the Local Authority thereby facilitating influence on the wider determinants of health and well-being for our population. The challenge was to implement a systematic and robust system for the implementation of NICE guidance throughout the organisations involved in delivering primary health and social care whilst working alongside the local health economy. This paper describes our experiences in achieving this.
North East Lincolnshire Care Trust Plus
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
The overall aim was to produce and implement a systematic and robust NICE system, shared in partnership between Health, Social Care and the Local Authority, whilst working collaboratively with our main secondary care provider in order to reduce health inequalities and to improve the health of our local population. The key objectives were: 1) To work in partnership with the local health and social care economy to produce a policy document outlining the Partnerships approach to the assessment, implementation and monitoring of all NICE guidance identifying NICE leads/champions to promote and support the NICE implementation process across the CTP and Local Authority 2) To ensure a user friendly, multi disciplinary process and supporting documents is in place to evaluate current practice against NICE guidance in order to identify the impact of guidance and the potential actions necessary to ensure implementation (including clinical and financial implications) thus identifying opportunities for quality improvement and where relevant, fed into the appropriate Committees/Groups 3) To ensure there is a comprehensive database to hold a wide range of information including the compliance status and progress in implementation allowing areas to be highlighted for further interventions such as through inclusion on the Clinical Audit Programme
In early 2007, a review was conducted in how the former PCT, Public Health, Social care and Secondary care Providers ensure the implementation of NICE guidance. The review found that there were pockets of good practice in varying stages of development across the organisations but current practice was extremely fragmented. The review also examined practices that were in place and examined the experiences of other organisations across the country in order to learn from the experiences of others both in terms of positive and negative outcomes! A fundamental concern was threat there were limited resources both centrally and with providers of care. There was a very real concern about the amount of work this proposed process would involve and the impact this would have on delivering patient care. We were frequently asked whether this would be another ?tick in the box exercise?. Would any work carried out by health and social care practitioners disappear into the ?infamous bureaucratic black hole?? There was a great deal of scepticism. It was evident that any system we developed would have to be ?real? in terms of achieving the overall outcome, but ensuring it took into account the pressures that all persons who would be involved were under. After many an hour of sweat and toil, we finally were able to produce the first outline of the system. Over the coming months, we ensured the proposed system was consulted on widely. We carried out several pilots of the system and gained feedback from as many of the stakeholders possible in order to ?tweak? the system. Many ?tweaks? later we had finally come up with a system that achieved our objectives.
1) A Policy document is in place outlining the approach of the partnership organisations to the dissemination, implementation and monitoring of all forms of NICE guidance. Clinical leads for the implementation and monitoring of NICE guidance have been identified (Medical Director supported by the Clinical Governance Facilitators and Public Health Consultant) 2) A user friendly baseline assessment form has been implemented, allowing all appropriate Healthcare Professionals to feed into the baseline assessment process thus ensuring a good level of clinical engagement. A baseline summary template has been designed to allow all individual baseline assessments to be collated and summarised in one document allowing a multidisciplinary baseline assessment to be reviewed by appropriate Committees/Groups. The terms of reference of the Clinical Governance Group, Health Improvement Partnership Board and Care Commissioning Group have been amended to ensure that all baseline assessment summaries are received, reviewed, implications identified and taken forward where appropriate. Round table discussions have been introduced for NICE Clinical Guidelines between relevant primary care Healthcare Professionals and secondary care Consultants with the aim of addressing any areas of ambiguity, sharing good practice and developing a consensus regarding the action plan to ensure consistent implementation across the local health economy. Where further action is required in terms of implications, an action plan template has been designed to allow identified NICE coordinators to form a detailed action plan. Where there are financial and/or commissioning implications a process has been identified where the Medical Director can take forward issues at relevant groups such as the Joint Planning Forum
results (continued) 3) A database has been set up to record all relevant information such as relevance to the organisation, overall compliance, monitoring/clinical audit activity (both in primary and secondary care), as well as allowing progress to be recorded. Queries have also been set up to allow quick reporting mechanisms 'at the touch of a button' Monitoring & Evaluation - Progress in relation to the implementation of all NICE guidance is recorded within the database and reports run on a bimonthly basis to inform the Clinical Governance Group of overall compliance and issues that require taking forward. - We have recently tied the completion of baseline assessments against NICE guidance to the PMS reviews, in order to promote further uptake! - We regularly share the findings of clinical audit projects across the primary-secondary care interface relating to NICE guidance - An agreement has been reached with our main secondary care provider to share the compliance status of all NICE guidance across the primary-secondary care interface - Work has commenced led by the Strategic Health Authority to share overall compliance status of all NICE guidance to allow benchmarking against other organisations in the area - The database is reviewed on a regular basis to identify specific pieces of NICE guidance which could benefit from using the quality improvement tool of clinical audit in order to include in the Clinical Audit & Clinical Effectiveness Work programme and is readily available to provide evidence in relation to meeting the standards specified by regulators such as the Healthcare Commission and the NHS Litigation Authority. - Over the last year there has been a steady increase in the number of baseline assessment being received and we have also been able to assess all relevant NICE guidance dating back to 2004
- Consult widely - Listen - Be pragmatic - Exchange skills and experiences - Don?t reinvent the wheel - Make everything user friendly - You can?t build Rome in a day - break it down into steps - Get people on board, dangle many carrots! - Try to get finance and commissioning involved early on - Tie the process in with the PMS reviews, Commissioning/Provider arms - Raise the profile of NICE guidance through the use of newsletters, outlining the regulators expectations - Don't be precious - Use opportunities - Secure resources - Feedback to the Healthcare Professionals what has happened as a result of the baseline assessment they undertook. If they can see the value they are more like to support the process - Carry out a baseline assessment of all relevant NICE guidance. - Showcase good practice/successful outcomes fro NICE guidance Further Areas to Develop - Continue to work with commissioning /finance/information - Continue to strengthen links with secondary care - Continue to raise the profile - To develop further the NICE System in light of developments within the provider and commissioning functions of the organisation
Risk Management Co-ordinator
North East Lincolnshire Care Trust Plus
Is the example industry-sponsored in any way?