Innovation Warehouse - Stories
Meridian is a resource for you to be able to share the changes that you have made to the way that you do things that have resulted in improved health outcomes for patients, a more effective way of delivering more for less, an increase in the productivity or just a different way of doing things.  Please use this space to upload the innovations that you wish to share and that others can benefit from.
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Innovation (Approved)

Overview summary:
In the UK and Western Europe most individuals with Osteoarthritis (OA) are managed in general practice with OA the second most common reason for consulting a general practitioner (GP).

The aim of JIGSAW-E is to implement a new model of supported self-management into general practice pilot sites in 5 European countries and evaluate the impact of this using local audits of quality care for OA. All innovations are designed for adoption and spread at pace and scale beyond pilot evaluation, and opportunistic adoption in developed sites is encouraged.
Challenge identified and actions taken :
JIGSAW-E supports practices in proactively managing patients with OA. The projects aim is to enhance quality of life for adults 45 years and over with joint pain without reverting to surgical treatment for OA unless all other appropriate options have been explored.

NHS England have recognised that given the significance of MSK (musculoskeletal conditions) to the NHS (£4.57 billion & 30% GP consultations) the recommended actions including pan STP collaboration across the pathway, could make a significant contribution to improving the quality of MSK care. NHS England has established MSK health as one of their key priorities.

JIGSAW-E supports general practice in addressing the following challenges:
  • Reducing clincial variation, through successful implementation of an electronic OA template to guide practice
  • Improve uptake of NICE guidance
  • Improve evidence based practice through supporting self management, train the trainer programme, local champions and training on the OA consultation
  • Improve patient satifsfaction and clinical outcomes through practitioner led long term condition clinics and bespoke patient information (OA guidebook)
  • Improving patient safety - reduced reliance on pharmacological/surgical interventions
  • Care pathway - reducing imaging and referrals to Orthopaedics
  • Improving work absense rates
Impacts / outcomes: 
JIGSAW-E addresses the unmet need in the management of OA across 5 European partners focusing on provision of quality non-pharmacological therapy: written patient information; exercise; physical activity; healthy eating and weight management advice. In 2016/2017 JIGSAW-E introduced a new model of supported self-management in general practice pilot sites and evaluated its impacts using audits of OA Quality Indicators collected using the JIGSAW-E e-template and routinely recorded general practice medical records.

JIGSAW-E supports the self-management of OA, providing a model of quality care incorporating four key primary care innovations:
  1. OA Guidebook - written information authored by patients and health professionals
  2. Model OA consultation for primary care
  3. Training for primary healthcare professionals in delivering high quality OA care
  4. Medical record (using e-template) and patient derivied Quality Indicators of OA care

Through EIT Health funding the project has also impacted on
  • the systematic implementation of international guidelines and NICE quality standards for OA at practice level across 5 European countries
  • Citizen and Industry partnerships supporting the scaling up of the this project across additonal EU partner countries

Highlight outcomes of the project so far
  • International Community of Practice for the project which includes key representation from across the 5 partner countries and the health professional groups of GPs, Practice Nurses, Physiotherapists and Patients
  • JIGSAW-E template embedded into clinical systems within practice within the UK. Translated templates are developed for partner countries as a local IT solution
  • OA Guidebook - translated and adapated across all project partners
  • Bespoke training package for GPs, Nurses, Physiotherapists and non-clincial staff. Training packages have been translated and adapted for use in partner countries and currently being converted into online training programmes
  • JIGSAW-E website providing supporting information for both clinicians and patients. Currently in the testing phase
  • Patient App
  • Strong industry links to be developed further in 2018
  • Business model in development
  • Network of clinical and patient champions supporting the effective roll out of the project
  • World leading patient and public involvement and engagement
Which local or national clinical or policy priorities does this innovation address:
NICE: Osteoarthritis: the care and management of osteoarthritis in adults
Supporting quote for the innovation from key stakeholders:
"The JIGSAW project promotes self management of OA amongst patients which encourages them to take a proactive role, understand the fuller implications of living with OA and to feel more ‘in control’ of their symptoms.

It helps to lessen pressure on secondary care services, and reduce the need for preventable surgery in some cases
 
I would strongly encourage other surgeries and multidisciplinary teams to embrace the project as its implementation has demonstrated positive outcomes in terms of improved quality of life; appropriate use of primary and secondary care services and satisfaction amongst health care professionals."

Practice Nurse, Portcullis Surgery, Ludlow, Shropshire
Plans for the future:
The project is now in its third year of funding from EIT Health. During the next 12 months the project will have a large focus on evaluation and the capture of key learning from the implementation across the five European partner countries.  Each project partner site will be developed into a beacon site for the project, supporting the scale up and out of the project.  Creating an business model for the project will be a key consideration to continue the growth of the project following the end of the funding period.

Digital innovations will continue to be built on over the next 12 months following the development of a JIGSAW-E website, online training package and patient app. 
The implementation of the project will continue to grow with new partners engaging in Europe and in the UK continuation of the adoption and spread of the project will take place across the West Midlands and beyond.

Opportunities to engage Industry in the project further will be explored.
Tips for adoption:
  • An understanding of Knowledge Mobilisation, theory and practice
  • Strong project management for effective implementation of the project
  • Phased approach to bringing on sites of implementation within an area
  • Recognising the impact of a pilot site to showcase best practice
  • Recognising the innovations may need to be flexible to meet the needs of different practices / organisations
  • The development of communities of practice to support the implementation of the project has been hugely successful
  • Development of a network of clincial and patient champions has been instrumental in the dissemination of information and encoragement of stakeholder uptake
  • Development of a busines model to support scale up and adoption
Contact for further information:
Nicola Evans
Implementation Project Manager, Impact Accerator Unit, Keele University
n.evans@keele.ac.uk 01782 734868
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Nicola Evans 17/01/2018 - 16:06 Approved
Overview summary:
A new programme in the West Midlands region aims to recognise and support general practices that deliver technology enabled care services (TECS) as their usual care, to ensure that their patients are empowered by their effective delivery. These local networks of digital exemplar practices are expected to lead the way in their STP to accelerate the adoption of TECS at scale, focused on long term condition pathways and the prevention of deterioration of health conditions. 
Challenge identified and actions taken :
Challenges: Currently across the NHS there is an ad hoc approach to digital delivery of care, an over focus on technology rather than its clinical application, an inadequate investment in digital skills/training of the NHS workforce, with solutions that place greater pressure on clinicians rather than enhancing productivity and quality of care.
 
Action: Development of a digital exemplar programme for general practices based on 7 key ‘C’ principles, with resources/training.
 
1. Competence. Practices’/patients’ ability to use/implement TECS.
 
2. Capability. Practices/patients need to adopt best practice using TECS and act on advice/information.
 
3. Capacity. Staff need time/confidence to innovate.
 
4. Confidence. Practices need to be confident of infrastructure. Patients need confidence that technology is integral part of clinical best practice.
 
5. Creativity. Staff using technology need to identify new opportunities.
 
6. Communication. Sharing of documents & communication between team members/settings caring for same patient.
 
7. Continuity. TECS not a quick fix, sharing knowledge/skills is key so that all across general practice teams and interactions with clinicians in other settings are synchronised across long-term condition networks.
Impacts / outcomes: 
Each of the 12 general practices on our exemplar programme is being supported in planning their use of digital technology with clear metrics in place to help them judge the value of their implementation plan. The programme will also help practice teams to understand the time and investment needed to undertake a new digital approach properly and the outcomes that can be achieved or strived for.
 
Development of a network of digital practices.
 
Our learning website, video tutorials, online toolkits and action learning sets are being offered across the region and are already oversubscribed. Practices that are willing to innovate want some recognition for what they are doing and the digital quality mark that we have developed will do just that.
Which local or national clinical or policy priorities does this innovation address:
Enhancing digital literacy, GP Forward View
Supporting quote for the innovation from key stakeholders:
The Programme’s aim is to upskill and support practice teams to match our 7 C’s, which is crucial to wide scale adoption of Technology Enabled Care Services at the front line.
 
By being in the Digital Exemplar programme we hope to consolidate our IT innovations around best practice, improve patient care in a cost-effective manner. Also having the expertise of a AHSN led programme will have solid foundation for clinical governance, social marketing and ability to implement successful projects elsewhere across the STP and further.
Plans for the future:
We believe the West Midlands will become a rich environment for the tech sector to invest their time and ideas for delivery of care and at the same time help address some of the health challenges we face.
 
However, this is not a programme that is confined to the West Midlands. We’ve already discussed the approach with likeminded people in other regions as well as with NHS England so it is certainly something that can be replicated elsewhere.
Tips for adoption:
The patient lies at the heart of what we are doing and so long as practices are committed to achieving the 7 key ‘C’ principles, alongside the appropriate resources and training, we believe that there are few limitations as to what they can do to improve the use of a range of modes of digital delivery across primary care in their area.
Contact for further information:
Ruth Chambers - ruth.chambers@stoke.nhs.co.uk
Marc Schmid - marc@redmoorhealth.co.uk
 
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Paula Stather 10/01/2018 - 15:46 Approved
Overview summary:
All change begins with an idea.

Athlon are an experience design and technology partner who supports organisations and individuals that are bringing about change through digital transformation and innovation. 

With any innovation there are a number of challenges to overcome, such as; developing an idea into a fully formed solution, efficient testing and iteration, developing a brand, gaining support from stakeholders/potential funders and finally encouraging adoption.

We help you to formulate, refine, build and market your ideas.
Challenge identified and actions taken :
NYU - The Human Project - The largest ever long term study of what it means to be human
How do you keep 10,000 New Yorkers engaged in a 10 year study of themselves and the environment they live in? Athlon were chosen to address this challenge through developing an experience around participant onboarding & consent as well as developing the brand and interactive digital platforms.

Motorola Solutions - Empowering public safety professionals
Motorola Solutions partnered with Athlon to assist in designing their public safety enterprise, an ecosystem from where all other applications would be launched. Looking at hardware devices used by emergency first responders we re-imagined how they could be more effective in high pressure situations. We then created marketing materials to gain support as the products were introduced to governments across the world.

Palmtree - Launching a successful startup
Guidant Technology are a start-up seeking to disrupt the way global organisations manage staff compliance. Athlon were appointed to create and brand their new product. Working from an initial idea of wanting to make compliance information more accessible, easier to explore and relevant to large teams we developed a brand and mobile app experience that helped this startup attract it’s crucial first three major clients.
 
Impacts / outcomes: 
The scenarios listed above resulted in successful, well designed, human centred solutions. Our support helped each one demonstrate their ideas and gain the necessary backing required at different stages of their innovation journeys in order to progress to being launched publicly and/or commercially.

The Human Project continues to grow in strength with additional research themes being added, whilst Motorola’s public safety devices have been shipped globally. Palmtree counts tech pioneers such as Apple and Spotify amongst its illustrious clients.
Which local or national clinical or policy priorities does this innovation address:
The UK Gov's £86m pledge to fund the development of new medicines and devices
Supporting quote for the innovation from key stakeholders:
Working with Athlon was a great experience. They partnered with us across our branding, product design and marketing. Their holistic approach, strategic insights and creative thinking helped accelerate our speed to market. I'd happily recommend them.

GARIN BERGMAN, FOUNDER & CEO, PALMTREE
Plans for the future:
Athlon continues to grow its team and capabilities across the UK, Europe and North America, currently expanding our user experience, strategy and marketing resources.

Our innovation lab is currently in development and looks to be an exciting testing ground for new ideas and technologies both for established organisations and startups.

We regularly dedicate time to investigating the most influential technology trends with our latest thought series exploring healthtech - please see our website for more information: https://www.weareathlon.com/collections/healthtech.
 
Tips for adoption:
Teaching organisations to have a ‘design thinking’ mindset is how we help to drive a human centred approach to innovation.

Our workshops provide tools and techniques to disrupt linear thought patterns and help identify creative opportunities. We find this is the best way to help our partners to adopt a holistic approach to thier challenge.
Contact for further information:
Sam Bhatt, Growth Manager - 0203 384 0470 -  sam@weareathlon.com
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Sam Bhatt 30/10/2017 - 13:42 Approved
Overview summary:
Making a difference to people with diabetes aims to make 1,000 positive differences for people with diabetes with 500 difference makers, developing a self-motivating network of change agents to give people the confidence, tools, know-how and enthusiasm to make a change to what they do what they do and improve patient experience and care. 
 
Challenge identified and actions taken :
Diabetes expenditure is approximately 10% of the NHS budget, with the West Midlands spending £94million on diabetes prescriptions between April 2012 and March 2013. There is also a wide variation in the achievement of good clinical outcomes. Only 16% of patients who are prescribed a new medicine take it as prescribed, experience no problems and receive as much information as they need. In primary care, around £300million per year of medicines are wasted (likely to be a conservative estimate), of which £150 million is avoidable. NHS England has a priority on medicines optimisation, which aims to deliver improved patient outcomes through a patient-centred approach. 
 
 
Impacts / outcomes: 
Difference maker: Emma Innes, Matron in Diabetes, in conjunction with the In-Patient Diabetes Nurses
Project outline: Redesigned the in-patient pathway at Worcestershire Royal Hospital by proactively seeing all patients on the Acute Medical Unit who were high risk: newly diagnosed diabetes, admitted with hypoglycaemia <4 or hyperglycaemia >11 mmols or use Insulin. The aim was to be able to review and intervene in diabetes management before the effects of acute illness, poor oral intake and non-specialist management could cause any adverse events with the diabetes control.
Difference made:
  • Over nine months after the service change, the diabetes errors on the Acute Medical Unit reduced to 0 from 10 errors recorded over the nine months prior
  • Increased number of patients seen by the DSN team initially, but this is balanced by the fact that patients on the medical wards are more stable due to the early intervention.  

Difference maker: Dr Andrew Askey, GP, Walsall CCG
Project outline: To improve screening for renal complications in people with diabetes by ensuring they have annual urinary albumen:creatinine ratio performed. An EMIS prompt was designed to alert clinicians when ACR screening was due, and further refined to advise on READ coding microalbuminuria or proteinuria and prescribing appropriate medication (ACEi, or AiiR blocker).
Difference made: In 2014, 469 people with diabetes had ACR screen in my practice, increasing to 613 in 2015 with an increase of 144 people screened.  In addition, 55 patients were coded with microalbuminuria or proteinuria, and 28 were started on ACEi medication.


Difference maker: Sat Kotecha, community pharmacist and Chair, Local Pharmacy Network, West Midlands
Supporters: I involved my pharmacy team, patients and the Health Trainer that works from my pharmacy. I also engaged with other pharmacies, a consultant and the company that make the disposable HBA1c tests - the LPC is currently putting a business case together for commissioners to consider.
Project outline: I believe that the person who can make the biggest difference to their diabetes is the patient themselves. However, as diabetes is a 'silent condition', people have no idea if the changes they make are making a difference. I wanted to give people an objective measure to motivate them to make a difference for themselves by measuring HBA1c at baseline and the patient receiving advice on medicines adherence, diet and exercise. There was then a series of follow ups to measure the impact and motivate the individual.
Difference made:
  • 18 patients participated in the service, 10 completed all four consultations, while the rest stopped at various intervals.
  • A range of HBA1c reduction from 3mmol/mol to 14mmol/mol
  • All 18 patients reported changes to diet and increases in physical activity
  • 11 patients reported improved adherence to medication/changes to timing etc
  • Eight patients stopped home BGT as they felt it was unnecessary
  • All 18 patients would recommend to friends and family. 

Difference maker: Julie Taylor, Diabetes Specialist Podiatrist, Staffordshire and Stoke-on-Trent Partnership NHS Trust
Supporters: podiatry line manager, professional leads for podiatry and physiotherapy, statistical support, non-medical prescribing lead, West Midlands Diabetic Foot Network, four GPs in four practices and diabetes consultant, Staffordshire University
Project outline: I wanted to improve timeliness of access to prescriptions for individuals with diabetic foot problems. Current processes cause delays that can have a negative impact on patient and carer experience and clinical outcomes. I wanted to make supplementary prescribing work in my community setting. 
Difference made:
  • My supplementary prescribing increased from 0 to 50 prescriptions, by developing clinical management plans with five independent prescribers (four co-located GP practices who had not experienced supplementary prescribing previously and diabetes consultant)
  • On these 50 occasions, times to prescription improved from minutes to 1 -14 days (from the GP practice)
  • My prescribing prevented at least one hospital admission
  • Nine prescriptions for antibiotics were provided during consultation (commonly delayed by days with existing process and often not in line with local guidance for foot infection)
  • 19 prescriptions for wound dressings/offloading devices that are often incorrectly prescribed due to similar names of products (which require additional prescriptions and associated delayed commencement of appropriate care plans) with a potential saving of >£150 and associated frustrations
  • More importantly, the patient and carer feedback has been very positive, notably regarding convenience and reducing anxiety.
Which local or national clinical or policy priorities does this innovation address:
Long Term Conditions, Quality improvement
Supporting quote for the innovation from key stakeholders:
 “WMAHSN are really good at promoting these great things, and the medicines optimisation programme has this drive behind it that engages people".
Plans for the future:
The initial group of people that made a difference have since gone on to do other joint working projects together and have created an energy and enthusiasm for having a go to make positive change happen.  The legacy of the programme is that the individuals involved have continued to pursue further changes and have made significant achievements at a personal and organisational level. 
Tips for adoption:
This programme is about driving improvement in diabetes and medicines optimisation without dictating how the difference makers achieve their goals. Instead, it has given people time to think and a framework to think differently, with some projects having wide impacts. There were some challenges during the programme which provide constructive lessons for the future. While the aim of identifying 500 difference makers to make 1000 differences was not achieved, the programme showed a rich experience of how a few people can make changes which impact the lives of many thousands of people with diabetes. 

Support for the difference makers included:
  • Two days training around change thinking
  • follow up half day
  • Teleconferences
  • Half day training on ‘Measurement for Improvement’
  • ‘Buddy system to provide support, challenge thinking and identify resources needed.
Contact for further information:
For more information, contact Lucy Chatwin, Business Manager at WMAHSN, on 0121 371 8061 or email lucy.chatwin@wmahsn.org  
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Lucy Chatwin 29/09/2017 - 16:19 Approved
Overview summary:
Many patients who are newly diagnosed with long term conditions(LTCs) or need active clinical management, are anxious and seek information and support from various sources, some of which are unreliable. To ensure that local patients were provided with appropriate support and reliable electronic information, we created three Facebook pages for general information, and three ‘closed’ Facebook groups to which clinicians invited patients to sign up. 
Challenge identified and actions taken :
Patients with the selected LTCs often have problems accepting their new circumstances after diagnosis. Adherence to treatment regimes can then be poor, yet it is crucial that they follow the advice given to them, if they are to manage their condition adequately. By having a peer group and health professional advice they are much more likely to change their behaviour appropriately.

Three general Facebook pages were set up, one for each of the conditions targeted, so information was presented to a wide public using videos and written posts. Three associated closed Facebook groups were established. Health professionals in relevant teams were trained to support the sites, intervene as appropriate in any peer to peer online discussions or inappropriate joiner’s contribution (e.g. commercial advertising) and regularly load interesting and relevant information pertaining to condition management and wellbeing.
 
The aims of using Facebook was education about patients’ condition, and support, especially for newly diagnosed patients. Thus, content might include highlights from research or updated approaches to management. Closed groups were created to enable patients to feel safe seeking advice from their peers, and discuss aspects of their treatment. Questions were loaded on each site to learn more of patients’ experiences.
Impacts / outcomes: 
These three closed Facebook groups now (1.8.17) have 451 users in total. The responses by the wider public to the general information videos filmed for the general Facebook pages has been extraordinary. One video by the consultant cardiologist for AF received 20,000 views. Videos of other cardiologists and cardiac rehabilitation patients have each been viewed between 300 and 13,000 times.
 
Members of closed Facebook groups are very active. As at 1.8.17 there are 120 members in the AF closed group; 110 in the cardiac rehabilitation closed group; and 221 in the MS closed group. The online discussions provide support for several hundred members who are able to discuss concerns with peers and interact with expert health professionals overseeing the site.
Questions posed via each Facebook site eliciting views of patients about the services produced positive responses:
  • 88% felt use of Facebook had improved their knowledge of their condition;
  • 93% said that Facebook had provided them with increased support;
  • 97% would recommend the service to their friends;
  • 50% reported that using Facebook had helped them make beneficial lifestyle changes.
Comments from patients valued the peer support:
 ‘Seeing other people’s experiences and identifying with them yourself’; others welcomed input from clinical staff: ‘Being able to get fast, accurate information without wading through the switch board and waiting for call backs. Also, being able to access support at a time that suits me rather than in office hours.’
 
Clinical staff have also commented that they have had far less telephone calls from patients worried about new medications: ‘They can discuss new treatments with other patients who are on them, so they don’t bother to contact us as they are reassured about side effects they are experiencing.’
The MS team have been awarded the MS Society Award 2017 in the MS Professional category. 
Which local or national clinical or policy priorities does this innovation address:
- Care and Quality - Health and Well Being - Drive to efficient and productive workforce
Supporting quote for the innovation from key stakeholders:
From patients –what is good?:
‘It’s comforting to know we can ask a question without it going public.’
‘Sharing experiences learning of different medications and things people do to alleviate symptoms.  The knowledge that there is someone to listen and get expert advice if needed.’
‘This group is great for interacting with other people with MS, I don’t feel so out of it alone.’
‘This group is great for having someone else there who understands what I am going through and can give advice.’
Patients from Stoke-on-Trent and Stafford                                                                          
From clinicians -insights:
‘Because it’s professionally monitored, we can correct false or negative information.  It takes the burden off the family too, as patients help each other to be more positive.  We’ve involved the MS Society; we promote local activities, and have got more volunteers that way.  It’s a partnership with them.’
MS Specialist Nurse
 
‘Initially we felt we needed to answer questions.  Now patients have often answered it themselves.  We are more relaxed – it’s now a support group.  They are very clued up about medication, and share tips, which we wouldn’t necessarily think of, intricacies of what makes life better for them.’
 
‘Take chest discomfort – initially we gave wordy answers to make sure we covered all possibilities.  Now, if we need to, we ask them to message us through a private inbox, giving their unit number, and we can look through their notes before replying, or give them a phone call.’
                                                                                                                       
Physio, Cardiac Rehabilitation
 
Please click on the link to view a video of Matt Berrisford, Exercise Physiologist, Cardiac Rehabilitation, University Hospital of North Midlands:
https://vimeo.com/203200412
Plans for the future:
WMAHSN support has enabled the pilot of the Facebook programme and dealt with organisational challenges such as NHS branding, governance etc. The success of the programme has resulted in national awards, where the excellence of these services has been recognised. This pilot proves the case for widescale adoption of Facebook for those with other LTCs in all health settings across UK and beyond; and optimise the links between trusted health Facebook sites, such as those piloted with local general practice Facebook sites.  Adopting other simple technologies such as Skype and text messaging are envisaged as additional ways of improving workforce efficiency. 
Tips for adoption:
  1. NHS reluctance to initiate Facebook sites can be overcome when health professionals and managers realise the low quality and unreliable information that is provided on unregulated sites to which patients gravitate if they are not given a suitable local or trusted outlet.
  2. Closed Facebook groups advocated by the NHS need to be monitored regularly by clinicians. But although this takes relatively little time, the material uploaded to a site does require regular oversight.
  3. The local nature of the Facebook group is important. There may be variations in treatment in different parts of the UK, and patients feel reassured by knowing that it is their clinicians who monitor the information displayed.
  4. Patients should be given details of the Facebook site at their initial diagnosis, because it is at this point that they will seek to supplement whatever information they have been given. To be directed to a local, trustworthy, informative and supportive network of patients is preferable to randomly finding unregulated and inaccurate sites elsewhere on the Internet. 
Contact for further information:
Marc Schmid
Project Lead
marc@redmoorhealth.co.uk
07736 008380
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Sue Wood 01/09/2017 - 10:40 Approved
Overview summary:
North Staffordshire and Stoke-on-Trent CCGs, with the support of the WMAHSN LTC Network and social enterprise company Redmoor Health, have been supporting their GP practices to use social media to engage with their patients.  As a result of the programme, over 2/3rds of the practices are now regularly using social media, the most popular being Facebook.  The topics discussed range from simple health messages to the publications of DNA data and consultations on appointment and telephone systems.
 
Challenge identified and actions taken :
The challenge is convincing general practice teams that it is in their best interests to have their own official Facebook landing page providing accurate and useful patient information individualised to the practice. Otherwise an unofficial page may be generated by the public (not necessarily registered patients) who access Facebook on their own devices and create a profile for the practice.  These publicly created pages are then unmoderated by practices, usually containing negative unpleasant comments about the practice services, which the practice is unable to control.  Unofficial pages can also be used to relay content not related to the practice, i.e. advertising businesses, which gives the mistaken impression that the advertisement has been endorsed by the practice.
Impacts / outcomes: 
Once practices realised that an unofficial Facebook page had been set up they were keen to develop an official Facebook page. By owning an official page (or claiming an unofficial one) practices can increase the likelihood that their patients reach their official site which are listed higher than unofficial pages in searches. Establishment of Facebook has enabled general practices to increase engagement with their patient population by sharing useful patient information including opening times, services etc. 
 
The practices engaged have also developed an effective communication channel.  This was highlighted in the 2017 cyber attack which affected practices throughout the country – telephone lines were down, websites couldn’t operate and online bookings were also affected.  Those practices with Facebook could send out information quickly to their patients with instructions to share across  personal networks.  As services came back online practice staff were accessing their practice’s Facebook page from home and posting updates to their patients.
 
When a video produced by the stroke team at University Hospitals North Midlands (UHNM) was posted across practice Facebook pages it received over 20,000 views in one weekend. A poster advertising a drop-in heart screening programme for young adults reached over 45,000 people in one weekend and sessions were fully booked within two days. A typical practice page engages around 200-1500 patients in a week, but this increases dramatically with posts that trigger significant patient interest.
 
Facebook is also now being used to recruit new members to practice Patient Participation Groups to enable those with difficulty in attending face to face meetings to become involved in more effective ways.
 
Some practices have also set up closed private Facebook groups for specific cohorts of patients who are able to discuss concerns with peers.
 
The review undertaken by the medical student has been accepted for publication by BJGP Online.
Which local or national clinical or policy priorities does this innovation address:
This should list the NHSE priority areas that the project addresses. These will be used to ensure the case study is easily searchable on Atlas: - Care and Quality - Health and Well Being
Supporting quote for the innovation from key stakeholders:
Seema Gater, Practice Manager Apsley Surgery, Stoke-on-Trent
“As a forward thinking practice we are keen to use social media to give patients a different way to interact with us. We wanted to provoke reaction and engagement and we have started to successfully tap into this by highlighting our monthly breakdown of DNA statistics to our patients though Facebook.”
 
Jane Cope, Practice Manager Goldenhill Surgery, Stoke-on-Trent
"We use Facebook as an opportunity to advertise and educate patients on seasonal topics, i.e. influenza vaccines in the winter, holiday vaccinations in the summer etc. and also other information that would be of benefit to patients."
 
As technology develops and more patients use the web to communicate, as a forward thinking practice, we see Facebook as a new innovative tool to communicate and educate patients."
 
A video has also been produced in which two PPG chairs discuss how they benefit from using social media: https://vimeo.com/digitalhealthsot/socialmediappgs
 
The following articles have been published regarding social media:
 
https://www.pcc-cic.org.uk/article/stoke-practices-engage-social-media
 
http://practicebusiness.co.uk/the-seven-cs-to-creating-a-digital-practice/?platform=hootsuite%E2%80%AC
 
http://www.pulsetoday.co.uk/your-practice/dilemmas/how-should-we-respond-to-negative-comments-on-social-media/20032472.article
Plans for the future:
As well as continuing to expand the network of Facebook practices, the pages that exist are being used to promote CCGs’ priority health messages and programmes. This includes signing patients up to Patient Online and engaging new parents on the future of maternity services in Staffordshire. By inviting parents to join a closed Facebook group, the CCGs have recruited 144 people to the engagement programme.
 
The North Midlands Breast Cancer Screening team is now using practice Facebook pages to promote their service and interact with patients to explore how the service can be improved and how non-attendance can be tackled.
Tips for adoption:
Embedding the use of Facebook into health and care engagement can have a huge impact on spreading positive messages and helping shape behaviour. It is not without risk though so there are some important considerations that need to be made:
  1. Training and support for frontline NHS staff
  2. Adoption of trustworthy, safe protocols
  3. Dedicated clinical time set aside to manage the regular engagement with patients
Once these are in place, the toolkits and support packages that have been developed in the West Midlands will support any frontline staff use social media to engage with patients.  Click on the link below to access the Social Media Toolkit:
https://redmoorhealth.co.uk/wp-content/uploads/gp-social-media-toolkit-redmoor.pdf    
Contact for further information:
Marc Schmid
Project Lead
marc@redmoorhealth.co.uk
07736 008380
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Sue Wood 01/09/2017 - 10:30 Approved
Overview summary:
This initiative aimed to improve understanding of the challenges pharmacies face in the adoption of technology enabled care services (TECS) focussing on efficient medicines utilisation and adherence.  
 
20 pharmacies from North Staffordshire were approached with 17 agreeing and 5 remaining through to completion.  The patient cohort was defined as those with prescriptions for COPD, asthma, diabetes type 2, diuretics, NSAIDs or back pain with protocols developed by the WMAHSN LTC Network.

Further details on the study can be accessed here
Challenge identified and actions taken :
The challenge was how pharmacists might utilise TECS to add value to the delivery of the New Medicine Service (NMS) and Medicines Use Review (MUR) and Prescription Intervention Service at the point of dispensing, in the integrated care of patients. 

The aim was to improve patient convenience, experience and increase understanding of their conditions and thus improve patient participation in self care with subsequent clinical benefits and associated cost benefit in medication usage. 

The project focussed on:
  • Recruitment of community pharmacies then agreeing a Memorandum of Understanding (MoU) detailing expectations under the project.  The MoU included a bursary of £500 for participation in training, identification and recruitment of patients, data capture and evaluation (Appendix 1);
  • Training to pharmacists followed by the licensing of pharmacies for Florence simple telehealth with ongoing on site support from local clinical telehealth facilitators and the Local Pharmaceutical Committee (LPC);
  • Protocols in the specified LTC's providing TECS introduction pathways (Appendix 2)
  • Florence and Manage Your Health aide memoirs
  • Baseline survey of participating pharmacies at project inception and a post participation survey (Appendix 3)
  • Patient feedback on Florence 
  • Patient feedback on the Manage your health app 
Impacts / outcomes: 
This was designed and delivered as a discovery project. As a consequence, the impacts and outcomes are limited to learning.  Based on critical reflection and consideration of the evaluation and surveys completed as project actions the project team identified where the project could have been more impactful in terms of retaining the participation of those pharmacies that expressed an interest. Then better retention and participation rates could have secured higher incidence of TECS adoption from the cohort of patients covered by the project.  These conclusions and the resulting recommendations recognise the small numbers involved and that further exemplar projects would be required before at scale roll out could be considered.
 
17 community pharmacies expressed an interest and progressed to training and receipt of the MoU and were deemed to be fit to participate – five of these accredited pharmacies went on to complete the project.  The number of interactions (contacts with patients) reached 88 realising 93 incidences of patients becoming engaged with or interested in TECS (patients could elect for either / both Florence and the Manage Your Health app).  The demographics of the patients reached during the project shows 5.7% (5) to be children (<20years old) and 19.3% (17) to be older adults (> 59 years old).  With an even distribution of participation by gender (42M / 46F) and by condition the willingness of patients to consider TECS when introduced by the pharmacist could be considered high as the 88 patients – based on participation data collected at the pharmacy – converted or stated an intention to convert to simple telehealth or an app.
 
The conversion rate supported the hypothesis that community pharmacies are in a position to introduce and generate adoption of TECS during their participation in a single patient focussed care plan.  However, if the project was to be replicated more attention would be required in the recruitment and preparation of the participating community pharmacy teams.
 
  • The MoU in itself was helpful for recording and agreeing the basis of participation but it could have contained more on the objectives and outcomes expected from participating pharmacies;
  • Experience showed that while the strategic involvement of the pharmacist(s) was fundamental to placing the project in context for the pharmacy the pharmacy staff (including counter staff) were better placed to manage the interactions with patients on the practicalities of enrolling with Florence or the downloading and then utilisation of the Manage Your Health app;
  • Training for the pharmacy team would be better delivered out of hours or by remote delivery (e.g. skype) as the day to day operations of the pharmacy made the delivery of training during opening hours problematic with frequent breaks in the training being required and on some occasions the training could not be completed within the time slot allotted for it;
  • The community pharmacies without exception had sufficient private space in which to interact with patients but they would benefit from more mobile IT to improve the content and value of the interactions e.g. by demonstrating TECS on an iPad to an interested customer;
  • In project planning, more could be done in helping community pharmacies understand patient flows and when this type of activity might best be done – during the project more than 40% of activity took place on a Friday with 20% on a Wednesday;
  • Survey at inception showed a healthy degree of scepticism on behalf of pharmacists as to the demand TECS would make on their colleagues but that TECS was an important and legitimate part of the pharmacy role. They agreed that the introduction of TECS into patient care was desirable and likely to improve their outcomes – the post participation survey illustrated that pharmacist time with patients was the key factor in patients adopting TECS (within the constraints of the project offer) and that TECS should be part of the pharmacy menu of services; and
  • Future initiatives would benefit from a much closer link with the outcome responsibilities placed on community pharmacies for NMS, MUR and the prescription intervention service as the project did not provide any causal link from the pharmacy activity to medication utilisation, adherence of cost effectiveness in prescribing.
 
It is worth noting that the demographics of the patient cohort recruited suggested significant levels of participation by older age groups generally considered to be ‘digitally excluded’. However, in the post participation telephone survey – albeit for small numbers – pharmacists reported patients not having a mobile phone (telehealth) or a smart phone or tablet (Manage Your Health app) as only occasional incidental occurrences.
Which local or national clinical or policy priorities does this innovation address:
Care and Quality Health and Well Being Health Education England’s Building a Digital Ready Workforce. https://hee.nhs.uk/our-work/developing-our-workforce/building-digital-re...
Supporting quote for the innovation from key stakeholders:
During the post participation survey the following comments were noted based on conversations with the participating pharmacists and pharmacy teams:
 
“Patients felt that the info on the Apps was reliable rather than just looking on the internet”
 
“I can see the benefits of using technology ………… new launches always take time, cannot expect new service to be instantly successful.  Once established and embedded expect it to be more successful”
 
“It would be good to have a self-service portal (in the pharmacy) i.e. tablet/lap top for patients to use to become familiar/comfortable”
 
“Pharmacist would have liked more telephone support”
 
“Delivering healthcare technology is easier than pharmacists believe …..”
 
“(The) Service is easy to sign up to but (I) just haven’t got the time. …….. apologies for lack of participation but owners not prepared to commit to staffing required”
 
“Try to link patients’ info and needs with the pharmacy from GPs.  Create better awareness – leaflets, posters, media and promotional material – poster/leaflet to encourage patient/customers and make aware
 
Please note:  These references are from notes taken during the post participation telephone survey and have been presented out of the context of that survey and the individual discussions that took place and, in some instances, represent multiple responses on the same or similar themes.
Plans for the future:
The learning from the initiative was substantial and consequently there would need to be significant redesign before it was run again.  There was much to commend the project recognising that it ran for a short time and yet the take up or conversion rate to the TECs offer was in itself significant and therefore of value in the context of what the project hoped to achieve.
 
The case for another initiative involving pharmacies and pharmacy teams is strong providing there is a greater emphasis placed on how their investment of time in introducing TECs impacts positively on pharmacy relative and important outcomes.  There is a valid argument for developing and introducing a currency for this work that is of value to pharmacies.
 
Since this initiative, Healthy Living Champions have been introduced into all pharmacies in Northern Staffordshire and it would make good sense to have them involved in this type of initiative in the future. Healthy Living Champions have a role to promote Public Health messages.
Tips for adoption:
The initiative brought home the importance of securing senior pharmacy managers support for the community pharmacists’ wider role, recognising that they need protected time to be effective.

Community pharmacists are motivated to use their knowledge to help patients, and projects like this one should capitalise on this.

If locations, such as pharmacies, are to be the focal point of introducing TECs to patients and the public promotion and support material for use on site is important.
 
Much is assumed about the digital awareness of professionals and employees in health and health care services – the initiative identified that greater digital awareness created by other programmes may help the future recruitment of willing participants from within clinical and healthcare teams and from the public and patients.
Contact for further information:
Tania Cork
Chief Operating Officer
North Staffs & Stoke LPC
taniacork@northstaffslpc.co.uk 
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Sue Wood 01/09/2017 - 10:21 Approved
Overview summary:
The Sutton Coldfield Unplanned Admission Avoidance in the Elderly Project involved six General Practices working together to design and implement a method of improving unplanned care for their patients over the age of 70.

Objective results showed a 20.0% reduction in hospital mortality for ACE project patients (p=0.014, ChiSq Test) with no comparable reduction for other local practices not in the project.

Approaching the project in a structured manner and learning service redesign skills maximised the potential for impact and positive outcomes.
Challenge identified and actions taken :
Experienced community nurses were employed to undertake urgent assessment and intervention in patients at risk of imminent admission and of all patients soon after discharge to reduce readmissions. A later additional work stream facilitated earlier safe discharge for inpatients, the ‘pull system’, with active monitoring via a live software feed with real-time details of admitted patients. Relationships between hospital and community medical and social teams were formed and strengthened and new pathway models planned and implemented.

Data collection was both subjective and objective.

The subjective data of ‘crisis’ admission avoidance indicated that 75% of interventions had a significant impact on reducing the likelihood of admission for a relatively low number of interventions each month. For post-discharge reviews this level of impact was much lower at 15%, but for a much larger number of contacts. Early safe discharge intervention demonstrated a moderate or more level of impact for at least 60% of up to 230 interventions each month.
Impacts / outcomes: 
​Objective results showed a 20.0% reduction in hospital mortality for ACE project patients (p=0.014, ChiSq Test) with no comparable reduction for other local practices not in the project.
There were significant reductions in both average length of stay and cost of admission. A system-wide change in average length of stay and cost was observed but the project practices saw greater reductions compared to the other local practices, and we estimate that we achieved an additional cost saving of £324,000 over 2 years.
Which local or national clinical or policy priorities does this innovation address:
Patient Safety, Unscheduled Care, Primary Care.
Supporting quote for the innovation from key stakeholders:
In conclusion, approaching the project in a structured manner and learning service redesign skills maximised the potential for impact and positive outcomes. The observed reduction in hospital mortality, in particular, points towards a significant improvement in patient safety. Reductions in cost and average length of stay also occurred but, as clinicians, nothing compensates for the significant time and effort involved in changing how our National Health Service functions better than the knowledge that patients are now less likely to be harmed.
Plans for the future:
Share the message and continue delivering and improving the service.  
Tips for adoption:
Invest up front in the Improvement Science Foundation training and support before attempting to replicate this elsewhere. 
Contact for further information:
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Simon Dodds 28/06/2017 - 11:41 Approved
Overview summary:
For three years now, dedicated staff in Birmingham Children’s Hospital have been using Appreciative Inquiry as the method for a programme called Learning from Excellence, and the WMAHSN has had such good reports of their work and such interest from its members that they have decided to support its rollout across the region.
Challenge identified and actions taken :
We all have a strong tendency to reflect on things that haven’t worked well, but Appreciative Inquiry helps us understand that we can learn much more from things that go well. It’s an idea that’s catching on in the mainstream, too. Increasingly, it’s an idea being used in sports psychology, where teams who review their good performance are shown to improve more than teams who review the things that didn’t go well.

Traditionally, safety in healthcare has focused on avoiding harm by learning from error, but this approach may miss opportunities to learn from excellent practice. Excellence in healthcare is highly prevalent, but there is no formal system to capture it.
Impacts / outcomes: 
When we learn from our good practice, morale and resilience is improved and our psyche is in a better position to learn. It’s called Learning from Excellence.

A series of introductory talks have ran called Where did it all go right? and then asked interested people to sign up for a two-day AI training course run by Appreciating People. We’ve been asked to provide five of these two-day courses, and they’ve all been fully booked. The participants on them have been amazing – dedicated, talented and really interested in using Appreciative Inquiry to take another approach to learning and enhancing safety.

The participants we worked with at WMAHSN really responded to using AI to create positive education, and work on their Quality Improvement. It helped them build resilience, as they were focusing on the things they were good at, and celebrated their successes.
Which local or national clinical or policy priorities does this innovation address:
Learning from Excellence - Patient Safety
Supporting quote for the innovation from key stakeholders:
In Learning from Excellence [learningfromexcellence.com/], Adrian Plunkett says: We tend to regard excellence as something to gratefully accept, rather than something to study and understand. Our preoccupation with avoiding error and harm in healthcare has resulted in the rise of rules and rigidity, which in turn has cultivated a culture of fear and stifled innovation. It’s time to redress the balance. We believe that studying excellence in healthcare can create new opportunities for learning and improving resilience and staff morale.'

Quote from a participant of AI training: ‘The Appreciative Inquiry training will help me to run round table meetings exploring episodes of excellence better. But it will also be useful for my everyday practice, where I will use its strength-based methodology to help me get the best out of the theatre teams I work in.’
Plans for the future:
Studying excellence in healthcare can create new opportunities for learning and improving resilience and staff morale. The plan is to continue to study excellence and create more opportunities for learning.

Also aim to get other health organisations in the region to begin to adopt Learning from Excellence and Appreciating Inquiry in their work of practice. 

 
Contact for further information:
Helen Hunt: helen.hunt@wmahsn.org 
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Manish Patel 02/06/2017 - 11:22 Approved
Overview summary:
The Safer Provision and Caring Excellence (SPACE) Programme has been developed by the West Midlands Patient Safety Collaborative (WMPSC), and is being designed and delivered in collaboration with Walsall Clinical Commissioning Group (CCG) and Wolverhampton CCG. It will run in 35 care homes across Walsall and Wolverhampton (all of which provide both residential services and nursing care) over 24 months.  The programme is being evaluated by the NIHR Collaboration for leadership in applied health research and care (NIHR CLAHRC).  
Challenge identified and actions taken :
Improving safety in care homes is becoming increasingly important. Care home residents typically have multiple physical and/or cognitive impairments, and adverse events like falls often lead to hospital attendance or admission. Developing a safety culture is associated with beneficial impacts on safety outcomes, but the complex needs of care home residents, coupled with staffing pressures in the sector, pose challenges for positive safety practices to become embedded at the individual and organisational levels. Staff training and education can positively enforce safety culture and reduce the incidence of harms, but improvement initiatives are often short lived and thorough evaluation is uncommon. The programme will train staff and managers in service improvement techniques, with the aim of strengthening safety culture and reducing adverse
safety event rates. The evaluation will use a pre-post design with mixed methods. Quantitative data will focus on:care home manager and staff surveys administered at several time points and analysis of adverse event rates. Data
on hospital activity by residents at participating care homes will be compared to matched controls. 
Impacts / outcomes: 
This mixed methods evaluation of a large-scale care home improvement programme will allow a substantial amount of qualitative and quantitative data to be collected. This will enable an assessment of the extent to which care home staff training can effectively improve safety culture, lower the incidence of adverse safety.
events such as falls and pressure ulcers, and potentially reduce care home resident’s use of acute services.
Which local or national clinical or policy priorities does this innovation address:
Patient Safety, Improved Quality of care, Prevention of adverse events, Improved staff morale, Improved Dementia Care
Supporting quote for the innovation from key stakeholders:
"Giving the Care Sector a voice"
"supporting each other to provide a positive safety culture"
Plans for the future:
Evaluation to be published in 15 months time 
Regional Care Home Conference in October 17 in the north of the Midlands 
Contact for further information:
Helen Hunt 
Assistant Programme Manager - PSC 
0121 371 8057
Helen.Hunt@wmahsn.org
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Helen Hunt 02/06/2017 - 11:15 Approved
Overview summary:
"Let's talk about anticoagulation" video gives information that can be shared with patients who need to consider having anticoagulation therapy.
 
Challenge identified and actions taken :
To support a consultation with a clinician.  The video shows the reasons for anticoagulation therapy, the choices available, including the risks and benefits of the different types.
Impacts / outcomes: 
Gives a simple clear understanding of anticoagulation options for patients and their carers.
Which local or national clinical or policy priorities does this innovation address:
WMAHSN reducing unwarranted clinical variation in AF
Plans for the future:
This video will be included as part of the toolkit of resources the WMAHSN is producing to support AF detection and treatment,
Tips for adoption:
To be used as part of a consultation.
Contact for further information:
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Karen Morrey 03/05/2017 - 14:50 Approved
Overview summary:
The film was developed by Wessex AHSN and will support practitioners with discussions with patients on anticoagulation but also be a tool that patients can return to after discussions in clinics. 

Anticoagulants are prescribed to prevent harmful blood clots that can lead to stroke.  They are designed to prevent or treat clots, but can increase the risk of bleeding. Patients and carers need advice and information about how these medicines work, and their potential side effects. To view the film in full please click here
Challenge identified and actions taken :
Many people taking anticoagulants don't fully understand what side effects to look out for, or when to seek help.  Starting Anticoagulation with Jack has been created to prevent people becoming unwell while on anticoagulant medicines, and avoid unnecessary admissions to hospital.
Impacts / outcomes: 
Anticoagulants are prescribed to prevent harmful blood clots that can lead to stroke.  They are designed to prevent or treat clots, but can increase the risk of bleeding. Patients and carers need advice and information about how these medicines work, and their potential side effects and to help them to improve adherence to prescribed medication.
Which local or national clinical or policy priorities does this innovation address:
Reduction of unwarranted clinical variation in Atrial Fibrillation
Supporting quote for the innovation from key stakeholders:
We’d like to share our new anticoagulation film with you and ask you to share it with your networks.
 
It would be really helpful if you could consider how it can be made easily accessible to patients to support them with anticoagulation treatment.
Plans for the future:
The West Midlands AHSN is working on an Atrial Fibrillation, (AF), programme to support clinicians, patients and their carers in the detection and treatment of AF.  We have an Advisory Group and plan to launch the first part of our project in May.  We will be developing a toolkit to support clinicians, patients and their carers.
Tips for adoption:
This film has been developed after significant research into what patients and their carers want to see.  It can be used to support clinicians explaining about the treatmen they are prescribing.
Contact for further information:
For information about our West Midlands programme contact:
Karen.Morrey@wmahsn.org
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Karen Morrey 29/03/2017 - 13:39 Approved
Overview summary:
Diabetes is a major health challenge in the UK with a rapidly increasing number of people affected. Active disease of the foot is a crisis situation for a patient with diabetes & requires timely referral & management. A new solution for reliable & remote monitoring of diabetes foot ulcers, Silhouette, was implemented as part of an integrated primary & secondary care pathway. This initiative is supported by EMAHSN.

Who’s involved? 
  • Entec Health Ltd
  • Aranz Medical Ltd
  • Derby Teaching Hospitals NHS FT
  • Derbyshire Community Healthcare Services NHS FT
  • EMAHSN
Challenge identified and actions taken :
The challenge:
  • > 61,000 people with a Diabetic Foot Ulcer (DFU) at any given time
  • 6,000 people with diabetes have leg, foot or toe amputations each year in England - many avoidable
  • Improving DFU outcomes can avoid amputations, improve quality of life & mortality
  • Total NHS spending on ulceration & amputation estimated at £651m
  • 50% of foot care expenditure in diabetes is for primary, community & outpatient care
Innovation deployed:
  • Technology-enabled new model of care: 3D wound imaging & information system - Silhouette®. Enabling routine DFU treatment to be delivered in the community
  • SilhouetteStar camera uses laser-assisted 3D measurement technology to accurately map wound size, enabling clinicians to assess wound progress & response to treatment with objective data
  • Supports reliable, reproducible & remote monitoring & management of patients with active DFU & chronic complex wounds
How?
  • The partners have collaborated to implement the Silhouette® 3D wound imaging system as part of an integrated pathway across both primary & secondary care
  • EMAHSN assisted with the procurement of the system & worked with all partners to get the new pathway implemented in four settings
  • EMAHSN is providing support with the implementation, communications, patient & public involvement, planning & procurement for wide adoption & spread
Impacts / outcomes: 
Impacts to date:
  • Moving 35% treatment sessions to community clinics forecast to reduce DFU service costs by 15- 20%
  • Patient feedback very positive
  • Quality of treatment maintained with opportunities for improvements
  • Secondary applications of digital wound imaging system being explored
  • Projected savings if deployed across the East Midlands: £0.9m-£1.8m per annum


Nigel Baggaley - Podiatrist at Ripley Community Clinic


SilhouetteStar Camera


Dr Bruce Davey - CEO ARANZ Medical with SilhouetteStar Camera

        
Which local or national clinical or policy priorities does this innovation address:
Long term conditions: a whole system, person-centred approach
Supporting quote for the innovation from key stakeholders:
Clinical Champion:
Professor Fran Game, Consultant Diabetologist, Derby Teaching Hospitals NHS Foundation Trust said; “This innovative service means patients can be seen and monitored much closer to home, outside of the often busy hospital environment. This is better for the patients and is also easing the pressure on our foot clinic at the hospital."

Service User, Patient Experience: 
Albert Sutton from Kilburn said; “We only live just down the road from the clinic and it saves so much time for us, it is much closer to home than the hospital is, which means we are not spending so much time getting to and from appointments.”
Plans for the future:
Next steps:
The project is being evaluated to confirm the health economic model and business case for spread of the innovation to other locations within and outside the East Midlands.
Tips for adoption:
  • Develop good relationships with all the key stakeholders.
  • Fully define the challenges experienced first, then consider if this is the right solution.
  • Ensure there is a clinical champion.
Contact for further information:
Achala Patel, Managing Director – achala.patel@entechealth.com
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Achala Patel 02/03/2017 - 12:43 Approved
Overview summary:
Four years ago Wandsworth CCG embarked on their Referral Management Programme and chose Kinesis as one of the core elements supporting it.
In 2015 Kinesis was used to seek advice on 3639 patients by GPs from across the CCG. The advice they received from specialists at their providers resulted in 1700 of these patients avoiding an outpatient referral & receiving faster access to appropriate treatment. They also saved over £300,000 in referral costs. Since then 6 further CCGs to adopt Kinesis and are beginning to see the same benefits.
Challenge identified and actions taken :
The average cost of an outpatient clinic referral is around £204.
In 2009 the problem associated with increasing referrals was reported by NHS Institute for Innovation & Improvement (Delivering Quality and Value - Focus on: Productivity and Efficiency. April 2009); evidence presented showed that “up to 65% of patients attending outpatient specialty clinics are discharged with no significant pathology being detected”.
NHS Midlands & East reported (Confer: End of Pilot Report 2012) “marked and ongoing increases in outpatient referrals” (13% during 2008/09 HES online) and discussed the demand management challenge for primary care commissioners and acute trusts. The trend has continued with 13.6m GP referrals in 2015, a 5% rise on the previous year.
Continued pressure on outpatient clinics due to increased demand, and the necessity of decreasing the time to appropriate treatment in order to minimise health costs and maximise clinical outcomes lead some organisations to wonder if there were better ways of supporting GPs when making referral decisions.
 
A Kings Fund Report concluded that supporting GPs in their practice to make better referral decisions was the best way forward (Referral Management – Lessons for Success. Candace Imison and Chris Naylor, Kings Fund 2010).
Introduction of Kinesis has begun to adress this
Impacts / outcomes: 
Since adopting the programme was a CCG now have 5 providers supporting over 40 specialties. All GPs in the area are able to request advice about a patient using a secure but simple browser-based application and expect to receive a reply within a day.
Wandsworth are on target to make over 4000 requests for advice this year with 58% of these resulting in a permanently avoided outpatient appointment.
6 further CCGs have adopted the same approach and are beginning to see equally positive results.
Where patients do need to be referred, this is often to the correct clinic with the right information and tests having been completed and, in some cases, an expedited referral since a specialist has effectively triaged the referral and is expecting this particular patient.
The benefits are not restricted to time-saving and cost saving. Patients benefit from greater reduced waiting times for appointments and treatment, and mostly benefit from continuing to be treated in primary care without a burdensome trip to hospital. GPs have responded I favourably to the system and report significantly improve care and treatment options for patients as well as being able to build relationships with their secondary care colleagues. They also report increased knowledge and confidence in their referral practice and this is reflected in the referral data. Meanwhile the specialists avoid their clinics being burdened with unnecessary referrals, ensuring they can spend more time with patients with greater needs; they also report enhanced relationships with their primary care colleagues and the ability to pass on their knowledge and expertise.

The experience at Wandsworth CCG is a sustained 5 to 1 ROI can be achieved within two years, based on avoidance of referral tariffs alone. It is believed (as suggested by the CCGs) an equal amount of savings are experienced across the health economy in terms of improved clinical outcomes, but this is not be objectively measured.
Which local or national clinical or policy priorities does this innovation address:
Referral management and reducing time to treatment
Supporting quote for the innovation from key stakeholders:
  • and there’s now an opportunity for us ALL to benefit from the recent progress
"It's a very well designed and easy to use system that bears no relationship to typical NHS IT"
Sarah Thurlbeck, Consultant Paediatrician, St Georges Hospital
 
"I think you have an impressive system in Kinesis. It's simple and intuitive and  really makes a difference."
Mike Conlon, Service Redesign Manager, Sutton CCG
 
"the issue isn't really about these savings, it's about the improved patient care…"
Dr Nicola Jones, chair Wandsworth CCG
 
Plans for the future:
We are in ongoing discussions with eRS to integrate Kinesis once they have released the APIs that will allow this. We are also aiming to integrate directly with the main primary care systems to make it even easier for GPs to request advice when required.
In the longer term we are looking at using machine learning to provide even quicker suggestions based on the responses from specialists.
However our main goal is to drive up the number of CCGs and GPs using the system and to increase the number of times they seek a conferral rather than a referral.
Tips for adoption:
  • Ensure that you have a dedicated programme manager - change management is harder than technology.
  • Get the support of your local seconary providers - the CEO is good to have on board, but equally find some individual specialist who really want this to work
  • Chase down any requests for advice that take longer than a couple of days to receive a reply - GPs need to have faith in the process.
  • Feedback to users on how much good it is delivering
Contact for further information:
info@kinesisgp.co.uk
or call Simon Hudson on  0773505295
 
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Simon Hudson 25/10/2016 - 17:15 Approved
Overview summary:
Move it or Lose it! supplied instructors to deliver FABS exercise classes to patients with COPD within Birmingham CrossCity CCG. Classes took place in the GP surgeries once per week, for 12 weeks. Physical and psychosocial wellbeing was monitored throughout. The results have shown incredible improvements in physical capacity including a reduced frailty, enhanced mental state following classes and high levels of enjoyment. Patients have reported reduced medication use showing potential for impact for wealth as well as health for the region. 
Challenge identified and actions taken :
There are currently 1 million diagnosed cases of COPD in the UK, and 2 million undiagnosed cases. It is the fifth biggest killer disease in the UK and costs the NHS an estimated £1.2 billion per annum. It is the second largest cause of emergency admissions accounting for one million bed day per year. 
Not only does COPD impact on the health of those with the condition, but it also places huge economical burdens on the NHS. 
Move it or Lose it! supplied instructors to deliver FABS exercise classes to patients with COPD within Birmingham CrossCity CCG. Classes took place in the GP surgeries once per week, for 12 weeks. Physical and psychosocial wellbeing was monitored throughout.
Impacts / outcomes: 
Following the 12 weeks of FABS exercise classes: 
  • 30s sit to stand scores increased by 120%
  • Timed Up and Go times improved by 27% to within the normal age-related range
  • Patient use of medication reduced, including steroids, antibiotics and COPD exacerbation pack 
  • Physical frailty reduced from 'mildly frail' to 'managing well' 
  • Patients reported high levels of enjoyment and social interaction 
Which local or national clinical or policy priorities does this innovation address:
Long-term health conditions
Supporting quote for the innovation from key stakeholders:
Patient quotes:
"I have really enjoyed the classes. This has changed my life!"
"Breathing is easier to control."

Here are some videos that demonstrate the benefits:
https://www.youtube.com/watch?v=lWFBTQGrILY
 https://player.vimeo.com/external/214476540.hd.mp4?s=efd5a41e987f6998e458bfa9f7089f750f605af7&profile_id=119
Plans for the future:
Scale the programme nationally and adopt for other long term health conditions such as diabetes, frailty.
Tips for adoption:
This programme can be delivered in GP surgeries where room allows, or in local community centres which are easily accessible.
Contact for further information:
Joe Robinson 
0800 612 7785
joe@moveitorloseit.co.uk
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Joe Robinson 19/10/2016 - 18:39 Approved

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