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Justin Schofield Hepatitis C MCN Manager NHS Greater Glasgow & Clyde Phase II Action Plan Aim: Evidence Provide overview of the process for establishing a hepatitis C MCN Strategic direction Investment Cross-cutting priorities & actions MCN core principles Management arrangements Identify stakeholders Map patient journeys Annual work plan Where to start? Service standards Who to engage with? Quality assurance Risks & potential benefits Hepatitis C MCN Co-ordinated approach to service development New ways of working Improve service to patients Content: Health Boards & partners How to manage process? A Managed Care Network is: A linked group of health professionals & organisations, working in a co-ordinated manner, unconstrained by existing professional and organisational boundaries, to ensure equitable provision of high quality, clinically effective services. Scottish Executive MEL(1999)10 http://www.mcn.scot.nhs.uk/pdf/mel199910.pdf 1. Management arrangements 5. Lead Clinician Network Manager 2. Structure Multi-disciplinary & multi- professional 6. Patient pathway 3. 4. Activities Outputs Benefits to patients Annual report Evidence base meaningful participation 7. Quality Assurance MCN accreditation Clinical governance, audit, risk management, patient safety 8. SIGN Clinical audit & research findings National & local evidence of need Patients & vol. sector Supported to enable Annual work plan Membership Education & training Continuous professional development Internal & external to MCN 9. Value for money Evidence that this has been explored http://www.nhshealthquality.org/nhsqis/files/HDL2007_21.pdf 2: Management arrangements Lead Clinician “… overall responsibility for the functioning of the Network” HDL(2007)21 Reflect role in Job Plan National forums MCN Manager / Co-ordinator Support Lead Clinician Project management Effective working relationships: ▪ ▪ ▪ Within MCN Upwards to Health Board Across external organisations Hep C Executive Lead Responsible for implementation of Action Plan i. ii. iii. iv. Prevention Testing, treatment, care & support Co-ordination Training, education & awareness raising Budget-holder Strategic overview National Hepatitis C MCN Clinical Leads’ Group (in development) • Share information, learning, resources & best practice • Avoid duplication of effort • Agree national standards National Hepatitis C Executive Leads Group (in existence) • National co-ordination & performance monitoring • Communication with HPS & Government 3: Identify stakeholders Testing & Referral Health Board Primary Care Prison Drug Services Public Health Health Improvement Public / Patient Involvement Inpatients GUM Maternity Services Finance Training BBV Prevention Planning CHPs Other MCNs Specialist Care Infectious Diseases Hepatology Gastroenterology • Ultrasound • Dietetics • Psychology • Psychiatry • Laboratory • Pharmacy • Service Mgrs Vol. Sector Drug Services Prison Social Care Mental Health Strategic or operational? Internal or external to MCN? Actively involved or kept informed? Patient Involvement Orgs. that advocate on behalf of people living with & at risk of HCV Directly with patients & clients Care & Support Primary Care Stakeholders Stakeholder analysis informs: MCN structure & membership Communication strategy 4: Map patient journeys Testing & Referral Primary Care Prison Inpatients GUM Drug Services Maternity Services Hepatology Gastroenterology • Ultrasound • Dietetics • Psychology • Psychiatry • Laboratory • Pharmacy • Service Mgrs People & information Specialist Care Infectious Diseases Identify Available evidence Care & Support Primary Care Drug Services Social Care Vol. Sector Prison Mental Health Key service providers Available resources Patient & information flows Barriers along journey Service pressures Gaps = opportunities for development Phase II Action Plan Surveillance data (HPS) Clinical database People with HCV Service providers knowledge Agree priorities Inform annual work plan Proposed developments Associated investment 5: Annual workplan MCN DEVELOPMENT Communications SERVICE DEVELOPMENTS Priorities informed by Web site Communication with stakeholder groups Annual report Bring key stakeholders into process Subgroups e.g. ▪ ▪ ▪ ▪ ▪ Prison liaison Outreach testing & referral Public & patient involvement Uni-professional groupings Clinical audit Quality Assurance MCN accreditation Treatment protocol Clinical audit National Action Plan Local mapping Define activities, outputs, & benefits to patients Develop infrastructure Membership & Structure Clinical staff resources Outpatient clinic space & locations Outreach staff & settings Agreement with partner agencies Pilot / launch developments Monitoring arrangements Activities Outputs Outcomes User satisfaction 6: Service standards Used to asses MCN performance National standard for hepatitis C services Sound evidence base, Clinical & care issues, Relate to the objectives of the MCN, Clear and measurable, Follow the patient pathway, Consistent with those for other hepatitis C MCNs across Scotland. Phase II Action Plan – Action 2 To be developed by QIS & national MCN Leads Network Due 2010 Phase II Action Plan accompanied by draft guidelines for hepatitis C MCNs Inform service standards National & local 1. Accountability and organisation 2. Policies and procedures 3. Testing 4. Specialist referral 5. Management and treatment 6. Care and support 7. Collaboration and partnership working 8. Patient information and awareness-raising 9. Education and training 10. Monitoring, evaluation and audit 7: Quality assurance MCN Accreditation NHS Board accredits local MCNs Existing process & support MCN must demonstrate: QIS Quality Assurance toolkit* Overview Guidance Templates 1. Plan to implement core principles 2. Service standards developed 3. Monitor implementation of core principles & standards 4. Reporting arrangements in place 5. Process for implementing recommendations * Toolkit provided with this presentation 7: Quality assurance MCN Accreditation Timetable: Yrs 1 & 2 Year 2: 2009 Year 1: 2008 • Secure stakeholder involvement • Define work programme • Secure public / patient involvement • Refine priorities • NHS Board endorsement • Establish education programme • Define MCN structure • Establish audit and research programme • Define patient pathway • Formal launch • Agree priorities & key improvement measures • Assess progress against QIS Quality Assurance model • Define the MCN communication strategy • Report progress to Board • Assess progress against QIS Quality Assurance model • Report progress to Board Risks and benefits RISKS Lack of corporate buy-in Threat to clinical autonomy Resistance to change Range of organisations with own pressures & priorities Bureaucracy Inertia Organisational capture by dominant partner Tokenistic user involvement BENEFITS Integrated patient care across professional & organisational boundaries Equitable service provision Reduce duplication of effort & resources Best use of scarce resources Innovation Patient-centred services Development opportunities for staff Key messages