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Establishing a Managed Care Network for Hepatitis C
Justin Schofield Hepatitis C MCN Manager NHS Greater Glasgow & Clyde
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Introduction Phase II Action Plan Hepatitis C MCN
Evidence Strategic direction Investment Cross-cutting priorities & actions Hepatitis C MCN Co-ordinated approach to service development New ways of working Improve service to patients Health Boards & partners Where to start? Who to engage with? How to manage process? Aim: Provide overview of the process for establishing a hepatitis C MCN Content: MCN core principles Management arrangements Identify stakeholders Map patient journeys Annual work plan Service standards Quality assurance Risks & potential benefits
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Definition A Managed Care Network is:
A linked group of health professionals & organisations, working in a co-ordinated manner, unconstrained by existing professional and organisational boundaries, to ensure equitable provision of high quality, clinically effective services. Scottish Executive MEL(1999)10
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1: Core principles Management arrangements Structure Annual work plan
Lead Clinician Network Manager Structure Patient pathway Annual work plan Activities Outputs Benefits to patients Annual report Evidence base SIGN Clinical audit & research findings National & local evidence of need Membership Multi-disciplinary & multi- professional Patients & vol. sector Supported to enable meaningful participation Quality Assurance MCN accreditation Clinical governance, audit, risk management, patient safety Education & training Continuous professional development Internal & external to MCN Value for money Evidence that this has been explored
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2: Management arrangements
Lead Clinician “… overall responsibility for the functioning of the Network” HDL(2007)21 Reflect role in Job Plan MCN Manager / Co-ordinator Support Lead Clinician Project management Effective working relationships: Within MCN Upwards to Health Board Across external organisations Hep C Executive Lead Responsible for implementation of Action Plan Prevention Testing, treatment, care & support Co-ordination Training, education & awareness raising Budget-holder Strategic overview National Hepatitis C MCN Clinical Leads’ Group (in development) National forums Share information, learning, resources & best practice Avoid duplication of effort Agree national standards National Hepatitis C Executive Leads Group (in existence) National co-ordination & performance monitoring Communication with HPS & Government
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Public / Patient Involvement
3: Identify stakeholders Testing & Referral Primary Care Prison Inpatients GUM Drug Services Maternity Services Health Board Finance BBV Prevention CHPs Other MCNs Health Improvement Training Public Health Public / Patient Involvement Planning Specialist Care Hepatology Infectious Diseases Ultrasound Dietetics Psychology Psychiatry Laboratory Pharmacy Service Mgrs Gastroenterology Stakeholders Strategic or operational? Internal or external to MCN? Actively involved or kept informed? Patient Involvement Orgs. that advocate on behalf of people living with & at risk of HCV Directly with patients & clients Stakeholder analysis informs: MCN structure & membership Communication strategy Care & Support Mental Health Vol. Sector Primary Care Social Care Drug Services Prison
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4: Map patient journeys Identify Available evidence Agree priorities
Testing & Referral Prison Inpatients GUM Drug Services Maternity Services Identify Key service providers Available resources Patient & information flows Barriers along journey Service pressures Gaps = opportunities for development Available evidence Phase II Action Plan Surveillance data (HPS) Clinical database People with HCV Service providers knowledge Agree priorities Inform annual work plan Proposed developments Associated investment Primary Care People & information Specialist Care Hepatology Infectious Diseases Ultrasound Dietetics Psychology Psychiatry Laboratory Pharmacy Service Mgrs Gastroenterology Care & Support Mental Health Vol. Sector Primary Care Social Care Drug Services Prison
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5: Annual workplan MCN Development Service Developments Communications
Web site Communication with stakeholder groups Annual report Membership & Structure Bring key stakeholders into process Subgroups e.g. Prison liaison Outreach testing & referral Public & patient involvement Uni-professional groupings Clinical audit Quality Assurance MCN accreditation Treatment protocol Priorities informed by National Action Plan Local mapping Define activities, outputs, & benefits to patients Develop infrastructure Clinical staff resources Outpatient clinic space & locations Outreach staff & settings Agreement with partner agencies Pilot / launch developments Monitoring arrangements Activities Outputs Outcomes User satisfaction
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6: Service standards National standard for hepatitis C services
Used to asses MCN performance Sound evidence base, Clinical & care issues, Relate to the objectives of the MCN, Clear and measurable, Follow the patient pathway, Consistent with those for other hepatitis C MCNs across Scotland. National standard for hepatitis C services Phase II Action Plan – Action 2 To be developed by QIS & national MCN Leads Network Due 2010 Phase II Action Plan accompanied by draft guidelines for hepatitis C MCNs Inform service standards National & local Accountability and organisation Policies and procedures Testing Specialist referral Management and treatment Care and support Collaboration and partnership working Patient information and awareness-raising Education and training Monitoring, evaluation and audit
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7: Quality assurance MCN Accreditation MCN must demonstrate:
NHS Board accredits local MCNs Existing process & support MCN must demonstrate: Plan to implement core principles Service standards developed Monitor implementation of core principles & standards Reporting arrangements in place Process for implementing recommendations QIS Quality Assurance toolkit* Overview Guidance Templates * Toolkit provided with this presentation
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MCN Accreditation Timetable: Yrs 1 & 2
7: Quality assurance MCN Accreditation Timetable: Yrs 1 & 2 Year 1: 2008 Secure stakeholder involvement Secure public / patient involvement NHS Board endorsement Define MCN structure Define patient pathway Agree priorities & key improvement measures Define the MCN communication strategy Assess progress against QIS Quality Assurance model Report progress to Board Year 2: 2009 Define work programme Refine priorities Establish education programme Establish audit and research programme Formal launch Assess progress against QIS Quality Assurance model Report progress to Board
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Risks and benefits risks benefits Lack of corporate buy-in
Threat to clinical autonomy Resistance to change Range of organisations with own pressures & priorities Bureaucracy Inertia Organisational capture by dominant partner Tokenistic user involvement Integrated patient care across professional & organisational boundaries Equitable service provision Reduce duplication of effort & resources Best use of scarce resources Innovation Patient-centred services Development opportunities for staff
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Key messages
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