Shared Decision Making – No decision about me, without me Kim Teasdale and Sam Hood Commissioning Managers South Tyneside and Gateshead CCGs

STCCG - What did we do and why? Shared Decision Making key component of our Referral Improvement Scheme (RIS) for 2012/13 – Demand Management project working with our GP practices to improve the quality of their referrals System pressures around elective activity particularly OP appointments in 3 specialities - General Surgery, Orthopaedics and Gynaecology – and focussed on 6 specific conditions within these Used SDM as a tool with the clinical teams to drive up the quality of GP referrals SDM is best practice and as a CCG we wanted to build it into our clinical culture and practice in South Tyneside

Referral Improvement Scheme (RIS) Shared Decision Making Practice Feedback / Support Implementing Best Practice Improved quality of care, increased patient satisfaction, Significant reduction in unnecessary OP referrals for patients and a subsequent reduction in cost of OP attendances (saving of £500k) including reduction in variation Better quality diagnosis and treatment of patients in primary care where appropriate (management of conservative measures etc.) Putting the patient at the heart of decision making about their own care

How did we implement Shared Decision Making? Shared Decision Making Education and Training GP MAGIC Champions Patient empowerment RIS scheme Direct Practice Support Development of Key resources – Top Tips / BDAs

Outcomes Better management of patients with these conditions – more confident GPs with more satisfied patients (questionnaire) Financial savings of around £500k in 1 st OP attendances for those 3 specialities Engagement with secondary care to adopt similar practice – early stage involvement in top tips / BDA development etc.

Next steps..... Advanced consultation skills - continuing to train GP trainer and embed in training culture in South Tyneside READ coding of MAGIC consultations with practice continuing promotion Developing SDM skills into Supported Self Management as part of our Improving Care Scheme for 2013/14 (STICS)

Why SDM? Opportunity to improve the quality of consultations in Primary Care Improve quality of referrals Improve outcomes for patients Increase patient engagement in their care – “no decision about me without me” Add value to the Q&P QOF process for practices through training in a new skill – SDM SDM ethos ties strongly with GCCG vision and values Improve patient experience of care

How? 2013/14 Quality &Productivity element of Quality and Outcomes Framework (QOF) indicators, applied to secondary care outpatient referrals (Q&P 1 – 3) Encouraged use more widely within general practice than just Q&P QOF Worked with the Newcastle SDM Team to put in place training for all Gateshead General Practices Training of CCG Core team and Executive GPs General awareness training July 2013 TITO locality meetings Shared Decision Making Skills Workshops September 2013 TITO – at least 2 GPs from each practice to attend Practice Nurse Workshops September TITO and September Diabetes Masterclass

Outcomes 68 GPs from 33 practices trained in SDM 2 x Practice Nurse workshops held focusing on SDM in LTCs Some GPs would like further training on practical application in consultations Positive response from Practice Nurses Practice Managers keen to begin to use Ask 3 Questions materials in their practices

Learning from implementation to date Support from CCG Executive GPs crucial to success so far Difficulty in training GP trainers locally Practice Nurse Trainers more success locally SDM v Pathway approach Practice Managers interested – links to patient participation, benefits for CQC inspections

Future Evaluate uptake of SDM at end of March 2013 Role out Ask 3 Questions materials to practices Look at how we can embed in Gateshead beyond 2013/14 and Q&P QOF Issues to tackle How do we know it’s made a difference to patients and empowered them? Once SDM team disbanded how do we grow our own support – particularly amongst GPs? Changing culture of General practice and patients to change their relationship with each other Evaluating impact on health system

Thank you