health:mk 1 The role of the Commissioning Librarian Anne Gray BSc, PGDipLib, MCLIP NHS Milton Keynes Presentation at HLG Conference 20 July 2010

health:mk 2 The White Paper The NHS will be held to account against clinically credible and evidence-based outcome measures(1.6) The Department is committed to evidence- based policy-making and a culture of evaluation and learning (1.23) NHS will, wherever possible, use clinically credible and evidence-based measures (3.4) (Equity and excellence: liberating the NHS, DOH, 2010)

health:mk 3 NHS Milton Keynes Quality Improvement model ► Primary care led - clinical leadership and engagement in strategic planning, pathway review and commissioning ► Evidence-based care and evidence-based commissioning ► Patient centred - public and patient engagement and interaction

health:mk 4 NHS Milton Keynes model How are librarians involved? Evidence based care: IMPACTE groups Improving Medical Practice by Assessing Current Evidence Evidence based commissioning: Supporting commissioners

health:mk 5 IMPACTE model follow through questions raised in routine primary care practice and look at the evidence to answer these use evidence to close the gaps between current ways of working and best practice make the evidence accessible “journal clubs”

health:mk 6 IMPACTE - What’s in a name? Journal Clubs Evidence Based Discussion Groups Improving Medical Practice Through CurrenT Evidence  IMPACTE Scary ! A mouthfu l

health:mk 7 What are IMPACTE groups? Primary care team initiative Build consensus to support changes across a whole team / system Questions raised in routine clinical practice Track down the best evidence What does the evidence tell us? So what? Establish a sustainable action plan Audit changes and followup

health:mk 8 Understanding the research evidence Centre for Evidence Based Medicine approach – PICO - is the article relevant to the team? – Was the research well done? (critical appraisal) – What can we learn from the results? – Are there any actions we could take to improve our practice? – Action plan

health:mk 9 Light touch statistics Learn to read the results tables Basic understanding of statistics eg p value, NNT, OR, funnel plot Further statistical concepts (hopefully) explained by session lead or librarian NOT an in depth critical appraisal session

health:mk 10 IMPACTE group model Relaxed, informal sessions Regular Topics of general interest with possible practical outcome Use “best” evidence eg EBM journal selections, NICE guidelines, Map of Medicine, “experts” Follow up actions and report back Pragmatic

health:mk 11 IMPACTE group membership Group organiser Session lead who has prepared a specific paper Health professionals eg GPs, nurses, pharmacists, AHPs, practice manager Librarian Find the evidence / support understanding eg statistics / write up / prompt for actions and follow up **Every group is different**

health:mk 12 Quality MK website Records of all discussions and analysis by topic IMPACTE toolkit : including – Hints and Tips on setting up an IMPACTE group – Where to find high quality evidence – Attendance list – Summary template – Attendance certificate/reflection Evaluation

health:mk 13 Where next? New groups across Milton Keynes - for patients & public - in other General Practices - online forum - in other clinical teams Continued funding to develop the model further Dissemination of the model – To clinical staff – To librarians – Paper by Prof Paul Glasziou to be published soon – Available to all on the website

health:mk 14 Commissioning Librarian a personal story Commissioners are not aware of support and resources available Commissioning Librarian involvment - Service design groups - Strategic boards - Team meetings - Talk to people Give people the information they need - Push and Pull Don’t wait till people ask but be aware of overload

health:mk 15 What do commissioners need? Best practice – guidelines, service specifications, case studies How to run a clinical service – location, processes, workforce, competencies Monitoring – performance, outcomes, audit How much does it cost? – health economics, cost benefit, prioritisation Tools – NICE, DoH, public health

health:mk 16 Knowledge Zone – Structure mirrors internal organisation – Dynamic resource, constantly updated – Links to existing resources “Where to find …” “Keeping up to date” “Commissioning Librarian” “Local library sources”

health:mk 17