DELIVERING PCI THROUGH THE CLINICAL NETWORK DR JIM HALL THE JAMES COOK UNIVERSITY HOSPITAL MIDDLESBROUGH

PCI National Service Framework CHD NHS Plan/ Modernisation Agenda NICE EVIDENCE BASED PRACTICE Performance Management & Framework PATIENT CHOICE Clinical Governance CHAI

PCI National Service Framework CHD NHS Plan/ Modernisation Agenda NICE EVIDENCE BASED PRACTICE Performance Management & Framework PATIENT CHOICE Clinical Governance CHAI CHD Networks

CHD NSF NETWORKS OF CARDIAC CARE “The usual model will involve linking tertiary cardiac centres, cardiac units in district hospitals and primary care. Typically the geographical boundaries of a network will match those of the PCTs whose populations are served by the relevant tertiary centre. The network should agree common referral criteria, treatment protocols etc ”

WHITEHAVEN NORTHALLERTON MIDDLESBROUGH DARLINGTON BISHOP AUKLAND DURHAM NEWCASTLE SUNDERLAND HARTLEPOOL NORTH TEES

CATCHMENT POPULATION TEESSIDE550,000 COUNTY DURHAM612,000 NORTH YORKSHIRE158,000 CUMBRIA238,000  TOTAL POPULATION ~ 1.5M

CHD NSF PCI CAPACITY Revascularisation waiting times –PCI –3 months maximum

CHD NSF PCI CAPACITY Revascularisation waiting times –PCI –3 months maximum ? 750/million

PCI and CABG rates per million in European countries in 2000

PCI JCUH

PCI RATES PER MILLION JCUH

PCI RATES PER MILLION JCUH

NORTH OF ENGLAND COAST TO COAST CHD NETWORK ¥‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’ è the patient’s journey predominates (the family test)

NORTH OF ENGLAND COAST TO COAST CHD NETWORK ¥‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’ ¥‘CHD Collaborative embedded within the network’ ¥‘commissioning advisor to the PCO’

NORTH OF ENGLAND COAST TO COAST CHD NETWORK ¥‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’

NORTH OF ENGLAND COAST TO COAST CHD NETWORK ¥‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’ ¥PCTTrustAmbulance ¥LAWDCLITsSHA ¥CHDCPCCBHF

NORTH OF ENGLAND COAST TO COAST CHD NETWORK ¥‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’

NORTH OF ENGLAND COAST TO COAST CHD NETWORK ¥‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’ sub-groups - ¥commissioning/performance ¥clinical ¥CHDC

NORTH OF ENGLAND COAST TO COAST CHD NETWORK òREGIONAL REVASCULARISATION STRATEGY òNETWORK ANGIOGRAPHY STRATEGY òNETWORK ICD STRATEGY

NORTH OF ENGLAND COAST TO COAST CHD NETWORK Clinicians sub-group òACS guidelines òemergency PCI guidelines òICD guidelines

NORTH OF ENGLAND COAST TO COAST CHD NETWORK ¥‘commissioning advisor to the PCO’ Jno direct commissioning role Jnot a managed clinical network

NORTH OF ENGLAND COAST TO COAST CHD NETWORK NEW DEVELOPMENTS Drug eluting stents - approx £1.6m if used in all 1500 projected cases GP IIb/IIIa ASD closure new thrombolytics RFA ablation of AF biventricular pacing others

NORTH OF ENGLAND COAST TO COAST CHD NETWORK CHALLENGES ý better links with PCTs ý better links with StHA ý better links with DoH  does this need a more formal structure cf collaboratives

CAPTAIN JAMES COOK

CHD NETWORKS not perfect not the finished article accountability performance management clinical governance (?peer review) managed clinical networks

PCI National Service Framework CHD NHS Plan/ Modernisation Agenda NICE EVIDENCE BASED PRACTICE Performance Management & Framework PATIENT CHOICE Clinical Governance CHAI CHD Networks