1. Reviewing the evidence base for ‘multiple site single service’ models of care
Ashley Dennison, Chair of East Midlands Clinical Senate
Matt Day, Consultant in Healthcare Public Health, Public Health England
David Bagguley, ST4 Public Health, University of Sheffield
on behalf of the East Midlands Clinical Senate Working Group

2. An increasing issue for Clinical Senates
Whilst they offer a potential solution to the difficult and often conflicting balance between outcomes vs access
Currently no agreed, shared definition of ‘multiple site, single service’ models
No support currently available to Clinical Senates to assist them when assessing these models
ttachment_data/file/570371/childrens_epilepsy_surgery_assessment.pdf
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3. So…
Establishment of a clinical expert group chaired by PHE which has defined the key questions for a clinical evidence review on multiple site one service models of care.
Undertaken a systematic review in partnership with PHE libraries team to understand the evidence base
Planning of national events to consider the experiences of other clinical Senates in this area and to consider these models and where they have worked successfully to improve outcomes.
Final report on the clinical evidence, workshop and accompanying framework for senates to utilise when considering these models
TB Delivery Board 4th May

4. Background to Review
Review team from Public Health England, East Midlands Clinical Senate and University of Sheffield
Systematic Review Protocol published in April 2018
Screening / Study Selection completed in Spring 2018
Presentation to National Clinical Senate meeting in May 2018
Data Extraction and Thematic Analysis completed Summer 2018
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5. Screening
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6. Study Type + 4 mixed methods studies 3 qualitative studies
4 cohort studies
1 cross sectional study +
4 mixed methods studies
3 qualitative studies
2 retrospective data analyses
1 data audit/analysis
1 expert opinion study
2 case studies/report

7. Key Questions for the Review
What is the optimal definition of a ‘multiple site single service’ model?
What is the evidence on patient outcomes and quality of care of ‘multiple site single service’ models?
What are the enablers of, and barriers to, the development of ‘multiple site single service’ models?
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8. Optimal Definition of MSSS models
Strong central coordination
Shared Governance
Adopt common policies / treatment pathways
Multi-site Single Service
All clincial sites maintain services
Some aspects of care provided by network
Can be enhanced by telemedicine
Clinical Network +
Feeder hospitals offer diagnostics, some tx
Smaller no. of centres offer advanced tx
Some central coordination
Clinical Network
Clinicians visit satellite units from specialist centre
Acceptable travel distance?
Specialist Outreach
Feeder sites assess and refer only
Common referral pathway
Specialist Centre
Increasing centralisation
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9. Evidence on Outcomes and MSSS models
Multi-site Single Service
Clinical Network +
Clinical Network
Specialist Outreach
Specialist Centre
Some evidence that patient satisfaction improves
No evidence from included studies that patient outcomes were negatively affected
Some improvement in treatment specific measures:
TAVI clinical network+ reported 90% of patient discharged directly home
30 day mortality lower within cardiac clinical network model than outside it
Some evidence that patients dislike transfer of care mid-treatment
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10. Evidence on Enablers of / Barriers to MSSS models
Finance
Workforce
Estate
Organisational Culture
Specialism
Geography
Systems Leadership
Access to data & Informatics
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11. Next Steps
Working Group to complete quality assessment / critical papers of included studies
Complete write up of paper in next 4-6 weeks
Aiming for submission of final paper by end of year with Senate Chairs as co-authors
Meanwhile, the themes identified will be used to inform qualitative study
TB Delivery Board 4th May