Transcript Document

Welcome to Wessex Strategic
Clinical Networks Transformation
Project Workshop
17/07/2015
Ensuring access to appropriate
neurological expertise
Dr Chris Kipps
Wessex Strategic Clinical Network
Mental Health, Dementia and Neurological Conditions
Aims of this workshop
1. To understand why patient access to
specialist neurological support needs
improving?
2. Neurological support services – what are
they and where are they?
3. What can be done to improve access to
existing services?
4. What else should be considered?
Why does patient access to specialist
neurological support need improving?
• Rising unplanned and potentially avoidable
neurological admissions
• Long waiting times for neurology referrals
• Fragmented care for patients with complex
long term conditions
• Limited capacity of consultant neurologists
and neurologically trained nurses
• Variable awareness and understanding of
neurological conditions among non-specialist
health and social care professionals leading
to delays and inappropriate referrals
What can be done to improve access to
existing services?
• Review and map neurological resources and
services across Wessex
• Identify neurological performance indicators
• Target referrals that do not always require
neurological assessment, e.g. headaches
• Specify safe, evidence-based pathways
• Establish an effective, affordable model for
Advice and Guidance schemes
• Improve information signposting for patients
Neurological support services – what are
they and where are they?
Neurological support services – what are
they and where are they?
Headache Pathway
Advice and
Guidance
Risk Stratification
Regional variation in emergency admissions
Percentage difference from lowest value CCG
180
160
140
120
100
80
60
Headaches and migraines
(primary diagnosis)
40
Headaches and migraines
(mention)
20
0
Regional variation in emergency admissions
Percentage difference from lowest value CCG
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Epilepsy (primary
diagnosis)
Epilepsy (mention)
Regional variation in emergency admissions
Percentage difference from lowest value CCG
250.0
200.0
150.0
Parkinson's (primary
diagnosis)
100.0
50.0
0.0
Parkinson's (mention)
At your fingertips…
http://fingertips.phe.org.uk/profile-group/mental-health/profile/neurology/
Turning this into relevant outcomes
Headache Pathway Redesign
Partnership project: West Hampshire CCG, HHFT, SCN funded by
Wessex AHSN
Project approach uses improvement science methodology
 Baseline surveys: diagnosis and management in Emergency
Department and Primary Care
 Demand and capacity baselines for neurology outpatients
 Headache referral to discharge pathway mapping, and outcomes
 Managed headache pathway proposal designed stratifying risk for
early access to neurological expertise or supported selfmanagement in primary care
 Design concept for headache clinical decision support tool
“HEADMAT” using digital innovation technology supported by
potential pilot locality in West Hampshire
Headache Pathway Redesign
Project Enablers
Audit baselines pre- and
post-implementation:
-GP satisfaction
-Current patient pathways
and outcomes
-Current referral rate
Design new headache
diagnosis and
management support tool
(HEADMAT)
Benefits
Improved quality of
clinical assessment and
accurate diagnosis of
headache presentations
More effective
treatment
Increased GP
satisfaction
Increased patient
satisfaction
Reduced outpatient
referrals
Reduced patient
waiting times and
faster access for
serious conditions
West Hampshire GP Headache Survey
What GPs think of their knowledge and skills in diagnosing
complex headaches
West Hampshire GP Headache Survey
What GPs think of a decision support tool for diagnosing
and managing headaches
West Hampshire GP Headache Survey
What GPs say that they need
“Better access to MRI head scan would be helpful – then I
am more confident in managing unusual headaches”
“I would like to be able to access CT scanning and then
the referral rate would drop”
“Telephone advice is hugely useful – current neurologists
are much more approachable than those we have had in
the past”
What else should be considered?
Feedback and discussion
Where do we look next to have the greatest impact on improving
access to neurological support:
 Commissioning engagement
 Mapping neurological pathways and pathway re-design
 Advice and Guidance schemes
 Critical events and risk stratification of follow up
 Decision support tools in primary care
 Sharing innovation and best practice in other conditions
For more information




Talk to us
Get involved
Complete a contact card
Access our websites:
http://www.wessexscn.nhs.uk/
http://www.wessexsenate.nhs.uk/
 Email us at [email protected]
Variation in emergency admissions
100
Crude rate per 100,000 18+ population
90
80
70
60
50
40
30
20
10
0
Source: Neurology Profiles, Public Health England, 2014
Headaches and migraines
(primary diagnosis)
Headaches and migraines
(mention)
Variation in emergency admissions
350
Crude rate per 100,000 18+ population
300
250
200
Epilepsy (primary
diagnosis)
150
Epilepsy (mention)
100
50
0
Source: Neurology Profiles, Public Health England, 2014
Variation in emergency admissions
140
Crude rate per 100,000 18+ population
120
100
80
Parkinson's (primary
diagnosis)
60
Parkinson's (mention)
40
20
0
Source: Neurology Profiles, Public Health England, 2014