Mark FlemingNational ICP Co-ordinator

Integrated Care PathwaysIntegrated Care Pathways

Ali El-GhorrProgramme Manager

Overview of presentationOverview of presentation

Policy context

Integrated Care Pathways

Standards for ICPs

Application in Primary Care

Discussion

John Loudon - Brin Jardine-Jill Gillies-Sean Doherty - Mark Fleming-Rosie Cameron

Ali El Ghorr - Selina Clinch-Alastair Cook-Linda McKechnie-Joyce Mouriki

Sam Atkinson - Trevor Johnstone - Elaine McKay - Susan McGaff - Gary Morrison

NHS Quality Improvement Scotland Mental Health ICP Team

ConclusionsConclusions

NHS Scotland is taking a national approach to ICP development and implementation in mental health

Focus on service user and meeting their needs

Top-down policy combined with bottom-up local ICP development

Supportive and facilitative approach

ICPs being used as a tool for service redesign and continuous quality improvement

Kerr report (2005)

“Need to improve access, quality and efficiency of NHS services”

Policy Context Policy Context

Delivering for Health (2005)

Delivering for Mental Health (Dec 2006):14 key commitments, and 3 national targets for each NHS Board in Scotland

Commitment 6 in Delivering for Mental Health (2006):

"NHS QIS will develop the standards for ICPs for schizophrenia, bipolar disorder, depression, dementia and personality disorder by the end of 2007.

NHS board areas will develop and implement ICPs and these will be accredited from 2008 onwards."

Integrated Care Pathway Integrated Care Pathway

A tool to compare planned care A tool to compare planned care

with care actually givenwith care actually given

Our Integrated Care PathwaysOur Integrated Care Pathways

Much more than a document of care given

Encompass how care is organised, co-ordinated and governed

Embody a system of continuous quality improvement

Mental Health Services Mental Health Services

NHS: Primary Care, Secondary Care, CMHT, others

Local Authority: Social Work & others

Voluntary Sector

Independent Sector

Others

Myth busting: Myth busting: What ICPsWhat ICPs are not

national

intended to stifle individualised care

additional paperwork

wholly dependant on IT systems

(not all variance is bad)

Impossible to give evidence of current quality of services

Lots of information currently being recorded

Lots of duplication

Lots of effort spent looking for information

ICP offers opportunity to rationalise recording of information, bringing it all together into one document

Opportunity to use resources more effectively

Why implement ICPs?Why implement ICPs?

Benefits to service usersBenefits to service users

ICPs will :

help improve assessment and care planning

ensure care is delivered in accordance with evidence and best practice

improve recording of care delivered and outcome achieved

“…the right care and treatment at the right time…”

Benefits to servicesBenefits to services

ICPs will generate information for identifying areas for development:

training needs identified to close skill gaps

need for service redesign

focused use of existing resources

“…expectations for local management…”

National Standards National Standards

Key standards for ICPs for the main diagnoses:

- schizophrenia

- bipolar disorder

- dementia

- depression

- borderline personality disorder

ICP StandardsICP Standards

- Process standards (how ICPs are developed)

generic

condition specific

- Care standards (content of ICPs)

- Service improvement standards (how ICPs are implemented)

Main Process StandardsMain Process Standards

Stakeholder involvement

Process mapping

Leaders and project managers identified

Recording and sharing of information

Referral systems developed

Care StandardsCare Standards

Service user at the centre of care planning

Comprehensive assessment

Risk management

A service user rated measure of needs (eg Avon)

Use evidence based interventions

Measure outcome

Support implementation of ICPs

Describe systems for reporting and acting on variances

Drive service redesign and continuous quality improvement

Service Improvement StandardsService Improvement Standards

Delivering togetherDelivering together

NHS Education Scotland

NHS QIS National ICP Co-ordinators

ICP Toolkit

Government

Social Work

Improvement Support Team Service users and carers

National

Regional

Local

Voluntary sector Workforces

Implementing ICPsImplementing ICPs

Will help NHS boards achieve their HEAT targets:

Stop increase in antidepressant prescribing

Reduce suicide rates

Reduce hospital re-admissions

What does this mean to What does this mean to Primary Care?Primary Care?

Primary Care InvolvementPrimary Care Involvement

- 4 GPs on our ICP development groups

- GPs & RCGP involved in consultation process

- GPs & others to be involved in local ICP development

- CHPs to be involved in local ICP development

What do Primary Care need to What do Primary Care need to do?do?

- Consider sharing anonymous information about diagnosis with NHS board

- Liaise with mental health services about referral protocols and care plans

- Consider how best to be involved in depression & dementia ICP care

Possible incentivesPossible incentives

- ICP links to Quality Outcomes Framework: Mental health register

Physical health checksDementia reviewDepression screeningDepression assessment using validated tool

- ICPs linked to HEAT target for reducing antidepressant prescribing

Other incentivesOther incentives

Delivering for Mental Health Commitment 3:

“We will work with GPs to ensure that new patients presenting with depression will have a formal assessment using a standardised tool and a matched therapy appropriate to the level of need.”

Benefits to Primary CareBenefits to Primary Care

- More and better quality information from mental health services

- Co-ordinated care package

- Holistic care based on service user needs

- Better outcomes for individuals and families

Standalone Depression ICP StandardStandalone Depression ICP Standard

For people who do not have complex needs:

Objective measure of depression (eg PHQ9)

Assessment of need leading to appropriate interventions (eg self-help, lifestyle advice)

Depression-focused brief psychological therapies offered

Treatment algorithm with threshold for:• antidepressant prescribing• psychological therapies• other evidence-based interventions

ApplicationApplication

Mark FlemingNational ICP Co-ordinator

ConclusionsConclusions

NHS Scotland is taking a national approach to ICP development and implementation in mental health

Focus on service user and meeting their needs

Top-down policy combined with bottom-up local ICP development

Supportive and facilitative approach

ICPs being used as a tool for service redesign and continuous quality improvement