tower hamlets managed practice networks john robson gp reader qmul nhs tower hamlets networks
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Tower Hamletsmanaged practice networks
John Robson GP Reader QMUL
NHS Tower Hamlets networks
NHS Tower Hamlets networks
Tower Hamlets in numbers 36 GP practices 150 GPs, 300 nurses, 100 health care assistants
Tower Hamlets in numbers
2000 staff 250,000 peopletwice size of Cambridge
NHS Tower Hamlets networks
• Health needs • How networks change provision and impact• Scaleable • Key levers
Outline
NHS Tower Hamlets networks
Welcome to Tower Hamlets
Newham Barking
RedbridgeWaltham Forest
Hackney
City
Tower Hamlets
East London Diabetes belt
1 in 20 have T2 diabetes
NHS Tower Hamlets networks
NHS Tower Hamlets networks
Where we are today
Iraq
East India
Albania
USA
UK
Japan
0 10 20 30 40 50 60 70 80
Tower Hamlets
United Kingdom
Male life expectancy 2002-9
NHS Tower Hamlets networks
NHS Tower Hamlets networks
The story
4 yrs top in UK and London
bottomquartileUK spend &performance
£2m
Diabetes CVD
Immunisation COPD
2008
36 practices in 8 local area networks
8
6
5
*
123
4
5
6
8
9
10
7
1112
15
13
16
14
17
18
19
24
2122
20
23
25
2627
28
29
30
31
32
Pop: 28,956
Pop: 23,868
Pop: 38,529
Pop: 33,948
Pop: 25,549
N7
N6
Practice Networks
33
35
34
36
NHS Tower Hamlets networks
NHS Tower Hamlets networks
Care Packages20102009
DiabetesCVD
cardiovascular
ImmunisationCOPD
chronic pulmonary disease
NHS Tower Hamlets networks
Success
• Childhood Imms 1st in London • Diabetes 1st in 2012 National Diabetes Audit
• CVD - BP and cholesterol control 1st QOF Statins 1st nationally
• COPD Spirometry/MRC rating 1st QOF
Resources for local complexity
Network manager• Performance
dashboards
• MDTs
• Target support
• Outreach
Practice managersClinical leads
• Finances collective target• Admin problems• Target resources• Educational needs• Peer to peer learning
Nurse Forum NHS Tower Hamlets networks
NHS Tower Hamlets networks
Priority, Guidance and Audit
Education: in-practice facilitation
NHS Tower Hamlets networks
NW1 NW2 NW3 NW4 NW5 NW6 NW7 NW8 BoroughApr-11 7.63 7.97 7.91 7.56 7.44 7.70 7.80 7.65 7.71May-11 7.67 7.95 7.93 7.56 7.45 7.68 7.78 7.63 7.71Jun-11 7.67 7.96 7.92 7.56 7.45 7.66 7.77 7.62 7.70Jul-11 7.70 7.94 7.95 7.63 7.50 7.71 7.78 7.66 7.73Aug-11 7.74 7.92 7.97 7.62 7.54 7.74 7.80 7.63 7.75Sep-11 7.72 7.91 8.00 7.59 7.52 7.74 7.78 7.60 7.75Oct-11 7.71 7.89 8.00 7.56 7.50 7.72 7.75 7.60 7.73Nov-11 7.69 7.85 7.97 7.52 7.51 7.76 7.75 7.59 7.72
7.10
7.20
7.30
7.40
7.50
7.60
7.70
7.80
7.90
8.00
8.10
Ave
rage
by
netw
ork
Network Average HbA1c
GP Network average for HbA1c for patients on register (excluding diagnosed within last 6 months)
VISUALISING CHANGE Diabetes HbA1c by network
Spitalfields
Thameside
NHS Tower Hamlets CCG
NHS Tower Hamlets networks
Network/practice monthly RAG red amber green chart
CVD
Target
Network AB AS CS LH GW
% Count % Count % Count % Count % Count
% new MI reviewed in 4 weeks post discharge
67.0%
57 4/7 50 5/10 60 3/5
80%
100 3/3 100 5/5
Network - practice engagement
NHS Tower Hamlets networks
NHS Tower Hamlets networks
Did we make a difference?
NHS Tower Hamlets networks
% T2 diabetes all 8 care processes Tower HamletsNational diabetes audits 2008-12
2008 2009 2010 20110%
10%
20%
30%
40%
50%
60%
70%
80%
90%
NHS Tower Hamlets networks
TOWER HAMLETS
Bottom
25%
Diabetes network
care package
1st
in E&W
Equity: age, ethnicity, deprivation
NHS Tower Hamlets networks
NHS Tower Hamlets networks
Inclusive & area based
• Inclusive: 3rd party providers & practice federations
• Based on LA local boundaries Local community and Integrated Care
NHS Tower Hamlets networks
• Widespread interest EVALUATE DISSEMINATE & PUBLISH
Directly influenced
• Newham clusters and federation: • Camden, South Wales, Waltham Forest• Scotland to Torbay
Generalisable
Natural experiment Tower Hamlets vs Newham & Hackney
NHS Tower Hamlets networks
Blood pressure control CHD (QOF)
Natural experiment Tower Hamlets vs Newham & Hackney
2004 2005 2006 2007 2008 2009 2010 2011 201275%
80%
85%
90%
95%
100%
EnglandLondonTower HamletsCity & HackneyNewham
% B
P <1
50/9
0mm
Hg
Blood pressure control CHD (QOF)
NHS Tower Hamlets networks
NHS Tower Hamlets networks
% Coronary heart disease: cholesterol <5mmol/lQOF no exceptions
2004 2005 2006 2007 2008 2009 2010 2011 201250%
60%
70%
80%
90%
100%
England
London
Tower Hamlets
City & Hackney
Newham
% c
hole
ster
ol <
5mm
ol/l
NHS Tower Hamlets networks
Impact
• 10% increase in antihypertensive and statins• 3m people with CVD diabetes• 40% reduction in events• 3000 CVD events and death every year
Impact
NHS Tower Hamlets networks
Myocardial infarction mortality under 75 years per 100,000 DSR ONS
2004 2005 2006 2007 2008 2009 201050
100
150
200
250
300
EnglandT HamletsNewhamHackney
MI m
orta
lity
rate
/100
,000
NHS Tower Hamlets networks
Key points
Key levers
Review & recall
IT DecisionPrompts
ActBelief Motivate
Guideline Education Comparative Feedback Incentives
Translational science
Three ducks in a row
NHS Tower Hamlets networks
Key points
Priority setting – choose carefully for maximum (evidence based) achievable impact
Engage stakeholders – consultants, prescribing advisors, LMC, nurses, practice managers – GP champions
Project or network managers
IT systems VISUALISE Performance - dashboards
Key levers
NHS Tower Hamlets networks
What happened next?
• Extended scope Atrial fibrillation, Cancer early diagnosis, Integrated care +++
• Networks as providers Took over failing practice
scaleable
• Entire CCG federatedprovider network
NHS Tower Hamlets networks
What happened next?
• Entire CCG federatedprovider network
Patient & community
benefit
NHS Tower Hamlets networks
Networks are a step change
20082014
NETWORKSPatient impact
Wider relevance
Transformational provision