Leeds and York Partnership NHS Foundation Trust
This submission describes the development of a summary of the NICE guideline on social anxiety disorder. When reading a newly published NICE guideline, Paul Blenkiron goes through the key recommendations and summarises them as a one page table so the relevant parts can easily be accessed and implemented by his clinical service and those he teaches.
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?
Aims and objectives
NICE guidance is comprehensive and covers the pathway of care a person should receive with a specific condition. However, some professionals may be uncertain as to which parts of a guideline may be most relevant to their practice and may defer reading even the guideline or quality standards due to time pressures.
The aim is to provide professionals with a clear, concise summary of relevant NICE recommendations in the format of a one page A4 table (see supporting material). This facilitates the implementation of NICE guidance by making the content easily accessible for use in day-to-day practice.
Reasons for implementing your project
Dr Blenkiron has previously developed digestible summaries of NICE guidance for mental health services, including summaries on generalised anxiety, panic, depression, obsessive-compulsive disorder and post-traumatic stress. Each uses the principles of the Stepped Care Model so that it is applicable across primary and secondary care. The focus is upon the clinical content of the guideline, which includes the triad of a) screening, identification and education about the disorder b) evidence based psychological treatments (in particular cognitive behaviour therapy- CBT) and c) drug treatments.
These summaries have been used as educational aides within workshops and lectures for NHS community mental health teams, trainee psychiatrists in North Yorkshire, Leeds University MSc Course and in national CBT workshops for the Royal College of Psychiatrists via their Centre for Learning and Conferences in 2012 and 2013. These summaries have proved very popular with healthcare professionals and so their development will continue. This submission concentrates on the summary produced for the social anxiety disorder guideline.
How did you implement the project
To speed up development, an initial draft was produced based on the draft guideline for Social Anxiety disorder. This was amended on publication of the final NICE guideline in May 2013. This was then circulated for comment to a) local clinicians to whom the guidance applied and b) NICE staff to ensure that the wording and content of the summary was robust and consistent with other formats for NICE guidance.
The main costs are the time taken to produce and review the summaries. The main barrier to dissemination is the need to continue to encourage professionals to prioritise their time towards awareness about new NICE guidance, given a background of NHS organisational change.
The Social Anxiety Disorder Summary is expected to be used locally and nationally to facilitate implementation of NICE guideline on social anxiety disorder. It will be included in professional development and teaching for:
a) Leeds University Psychiatry MSc Course lectures
b) North Yorkshire CBT Training Workshops held 3 days annually in York, and now extended to non-medical staff including nurses and social workers
c) CBT in Practice National Workshops for the Royal College of Psychiatrists Centre for Learning and Conferences in London, attended by GPs and senior psychiatrists.
The initial response to the summaries has been very positive, and further research is planned to ascertain their usefulness. As part of an educational evaluation project, all professionals who attend Dr Blenkiron's CBT training workshops locally and nationally are asked to rate their knowledge, skills and confidence before and after attending each workshop. A specially devised feedback form is used which includes four 10-point rating scales. Preliminary results have shown a significant increase in participants' self rated knowledge (up by 13%), skills (20%) and confidence (16%) after attending the workshop series. The median score for post workshop factual knowledge (assessed independently via multiple choice questions) is 77%, and participants' median rating for educational value of workshop content (including the NICE summaries) is 9/10 (very good to excellent).
Although it is difficult to assess the impact on practice directly, adherence to NICE guidelines is evaluated through a systematic trust-wide NHS audit programme. In the meantime other opportunities are being pursued to promote the summaries locally within secondary care and also more widely, for example through the IAPT (Improving Access to Psychological Therapies) Programme.
Key learning points
- 'Ownership' of guidelines (and guideline implementation) is likely to be improved when individual clinicians - and their organisations - produce their own distilled summaries.
- The key is to make summaries simple, specific and relevant to that particular area of clinical practice.
- Getting the summaries reviewed may be time consuming but promotes wider engagement, prevents significant omissions and improves quality.
- Clinicians who produce or lead development of local summaries should review the content when guidelines are updated or significant new evidence emerges.
Consultant Psychiatrist, NICE Fellow 2011-2014 and Public Education Officer for RCPsy
Leeds and York Partnership NHS Foundation Trust
Is the example industry-sponsored in any way?