Participative ICP development HIV ICP event: Stirling 26th March 2013 Rak Nandwani Consultant in Sexual Health & HIV Medicine NHS Greater Glasgow & Clyde

Overview of presentation To provide update on progress in NHS GGC To show process we are using to develop ICP To recognise value of engaging teams To identify where external input is required Willing to share anything others find helpful

Sexual Health & BBV Framework Builds on HIV QIS standards & Action Plan ICP direction set by Scottish Government HIV Clinical Leads Group Also takes account of other national guidance Framework Outcomes: HIV 1. Fewer newly acquired HIV infections 2. A reduction in health inequalities associated with HIV 3. People affected by HIV live longer, healthier lives 5. A society whereby the attitudes of individuals the public and professionals and the media in Scotland towards HIV are positive, non-stigmatising and supportive

Brownlee Clinic numbers 2001-2012

Starting point: the patient journey Show patients what the plan is Alternative routes tailored to individuals Patient responsibilities stated Shared care and sign-off Engagement of wide range of stakeholders

GGC ICP Event 6 Sept 2012 Linked to Health Board ICP workstream Facilitated by GGC Head of Organisational Development: SIPOC methodology Key personnel: some meeting for first time Consider the whole end to end pathway Review where own part sits in the pathway

The Icebreaker.. Consider the presentation and actions we now need to take Identify: One key hope you have for the outcomes of developing the pathway? One key concern? One opportunity you feel this might offer ? Write these down – one each to a post it page Take 5 minutes – speak to as many people – one at a time! – as you can in this time and share the above. Add to flip chart pages on the wall Hope Concern Opportunities

(Linkage Of Processes) Business Architecture (Functional Map) Level 0 Top Level Block Diagram illustrating the Functional groups and their relationships. Allowing a broad, easily understood picture of the Business as a whole. L.O.P Map (Linkage Of Processes) Detailed Map of all Significant Process Steps captured in Level 1 linking processes together based on their Inputs and Outputs. Allows personnel to picture where they fit in and where their links are. Displays the actual flow & sequence of events. Processes are numbered for ease of reference across the Business. Level 1 SIPOC Templates (Suppliers, Inputs, Process Steps, Outputs & Customers) Templates per Functions represented in Level 0 capturing important Inputs to each function , their owners, the function’s significant steps and Outputs from the function. This gives a general understanding of Functions’ operations and cross functional dependencies & responsibilities inc. Customer focus. Level 2

WHAT is it they provide to our process; Process Output Process name: Enter Text Here Process owner: Enter Text Here Suppliers WHO provides the inputs to the process Input WHAT is it they provide to our process; Material, equipment, appointments, hardware, software, training, resources, information, data, products Process Output WHAT does the process provide as an output from its activities. Completed treatment, an appointment schedule, a diagnosis, data, information, referral. Customers WHO receives the outputs; Patient, GP, Onward referral departments. Who else has an interest; management teams, committees, agencies. Finishing Point

Outputs from Campanile meeting Team-building event Understanding of dependencies of different parts of service Identified areas of difficulty and where decisions are needed to make improvement Sufficient outputs to produce draft HIV ICP

GGC First 3 months of HIV care ICP ASSESSMENT OF PATIENT NEEDS AND PRIORITIES FOR CARE Clinical assessment Wider health & well-being Sexual & reproductive health Body metrics Blood tests Urine & other tests SELF-MANAGEMENT SUPPORT PATIENT PARTICIPATION IN DECISION MAKING PHARMACIST ADVICE NEW HIV+ DIAGNOSIS (OR TRANSFER) ENTRY TO HIV CARE OR ACTION IF DNA ADVICE ON PARTNER NOTIFICATION AND PREVENTION OF ONWARD TRANSMISSION REGISTRATION AND COMMUNICATION INFORMATION GOVERNANCE CLINICAL DECISION MAKING AGREEGOALS WITH PATIENT: "CARE PLAN” CONSIDER ARV THERAPY DOCUMENATATION 1. List of main issues/summary can be in form of GP letter or note to file. Offer patient a copy 2. Include actions to be taken and likely timescales to complete 3 MONTH ICP CHECKLIST SIGNED OFF BY MDT STAFF EMERGENCY NON-HIV CARE GP/PRIMARY CARE HOME DELIVERY

NHS GGC draft HIV ICPs The Excel versions are in early draft form but we are willing to circulate to others once agreed locally. Please feel free to email me if you would like a copy: rak.nandwani@nhs.net

NHS GGC ICPs Whole pathway visible at once ICP for first 3 months of care Identified links to other pathways Definitions and data to identify variances Annual review ICP with branches on/off therapy

Next steps Further staff event to review draft ICPs Teams to claim lead responsibilty What’s missing and what can be removed Patient & third sector perspectives What decisions are needed (eg timing of visits) Documentation without duplication