ICPs for HIV care in NHS Tayside Morgan Evans Clinical lead

HIV in NHS Tayside 5 routine clinic sites (including HMP Perth) 270 patients majority on treatment Women – 36% Risk group 23% Hetero non-UK (acquired) 22% Hetero UK 23% IVDU 28% MSM <1% MTCT <1% Blood product 2012 figures New diagnoses – 15 Transfer in – 11 Transfer out – 5 Deaths – 8 Stratification 50% stable ART no ongoing health/psychosocial issues 25% stable ART some on going health/psychosocial issues 25% not stable on ART and/or significant health and psychosocial issues Staffing 1.5 WTE CNS in HIV 4 consultants now routinely involved in care (roughly 6 PA DCC) Pharmacist – 0.2 WTE 2 admin staff (1 WTE)

Drivers for change Improve service outcomes, quality and delivery of care Change in consultant staffing Wanting to define roles within the HIV team Move to 6 monthly follow up HIS standards/BHIVA standards Data collection  Front sheet  Annual review form

ICP First three months and transfer ins What happens at the moment? Reality mapping Who was doing what and when?

Reality map outcomes Referral sourceGP – electronic referral TSRHGP – electronic referral (+ve non- UK) Self referral via CNS (LTFU) Secondary care – viral hepatitis GP – direct to ID (+ve test previously) TSRHSecondary care – assisted conception unit Days from HIV test to referral received 49NA Tested by HIV consultant NA 3 Days from referral to seeing HIV doctor (DNAd OPA) 007NA Days from referral to seeing HIV CNS (home visit) Days from positive test to CD4 511NA (taken on day 0) 6 713

ICP Processes Important dates (diagnosis, referral, first review, first medical review) Patient details and consents (GP/students etc) Patient contact details including next of kin and emergencies Baseline investigations Baseline observations Clinical assessment and examination CVS risk assessment Bone risk assessment Drug history Sexual health assessment Family planning Psychiatric/psychological assessment and support Social assessment (smoking and alcohol) Education Disclosure support Partner notification Identification and testing of any children Harm reduction/behaviour change – to include recreational/non-prescribed drugs, smoking and alcohol. Preventative medicine (Including smears) Vaccination Occupational health assessment Discussion at MDT Pre-ART assessment Drug interaction assessment Toxicity and efficacy assessment Adherence assessment Epidemiological grouping and acquisition risk Viral hepatitis infection Problem list Care plan including first MDT meeting and onward referrals Service user feedback Variance lists List of ICP users

Where we are now Processes have been allocated to “leaders” Examples available Defining –  what should be done,  according to what standard  how it should be recorded  what should be monitored/audited  how should it influence the care plan

Challenges Showing the vision – over above the document Team/staff buy in Time! Balance – micromanaging v. laissez faire Outcomes – defining and monitoring Service user involvement