Transcript The Rheumatology framework

Agenda Item 4 (ii): BSR Strategic Goals
Status(pink): This paper is for Discussion and Approval
Explanation:
The rapidly changing economic environment and NHS structures has resulted in the
need to review the BSR Strategy every year to reflect change. These goals support this
strategy
Finance, implications and Risk:
There is a risk that the Society could become less relevant to members if unable to
support them and deliver the tools necessary for them to manage in this environment
Recommendation:
The Trustees are asked to discuss and approve the strategy
Prepared by and Queries to:
Laura Guest: [email protected]
Rheumatology
Strategic goals
Context
QIPP
Goals
Rheumatology Long Term Conditions
BSR – Strategic Goals over the next 5 years
informed by members survey, focus groups and
partners
Key Partners
• Individuals with rheumatic diseases and relevant patient support groups
• Government(s), nationally and internationally
• Other medical and clinical colleagues in primary care and allied health
professions nationally and internationally
• Professional bodies, academic community and university sector and
medical research charities
• Policy makers
• Commissioners
• The general public
• The NHS
Context: Rheumatology Conditions
Major health problem for England
• High disability Levels; A previously unseen and comparatively unrecognised cohort of
conditions in the U.K. 2nd ranked cause of disability. Will further increase NHS expenditure
unless measures are taken
•
Very common conditions; Musculoskeletal conditions affects 10 million people in the UK
(ARUK, 2010), with inflammatory arthritis affecting about 10% of these (around a million
people) (RCP, 2011), many of whom are young and of working age
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High costs for the U.K. NHS costs rising rapidly; Very expensive conditions: The cost of
RA alone to the UK economy is almost £8 billion a year (DH drug costs 2011, NRAS, 2010)
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Care is variable There is significant variation in the quality of care and patient experience
in all aspects of management (e.g. Kings Fund report 2010, Joint Matters ARMA 2012,
National Audit Office report on the management of rheumatoid arthritis, 2009)
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There is a need for better commissioning and needs assessment data commissioning
contract activity and measurement needs to reflect the Long Term Condition nature of
rheumatology
Context: QIPP and Rheumatology Conditions
There is potential for key QIPP initiatives; Quality improvement through addressing variation in
treatment and care; Innovation through implementing best practice; and in Prevention of
unnecessary disability and improvements in Productivity. For example:
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Care lags behind much of Western Europe; disease activity levels are higher
than in the Netherlands and Scandinavia , leading to irreversible damage and
incurring significant cost to the NHS and society
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Early effective treatment with cheaper drugs is needed; delays in treatment can
result in a more aggressive course to the disease, e.g.
i) NHS spends £0.5B on biologic agents
ii) Costs are increasing by 10 -20% per year, around £100m per year, long
way to go to reach levels of Western Europe and USA
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Major National Variations in Care
i) There is existing wide variation in treatment and outcomes. For example,
only 10% of patients are put onto DMARDs within 3 months of symptom onset in spite
of NICE guidelines.
ii) Only 63% of patients in acute trusts provided annual review for RA
patients to monitor disease progression and emergence of co-morbidities (NAO, 2009;
NICE, 2009)
Context BSR: Successes and Challenges
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Research focus developed
Some national standards and indicators
HQIP
Conference
Journal
BSR Biologics register and opportunities
Seen as lead for education, although not fully realised
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A lack of Rheumatology identity with policy and decision makers
On the cusp of requiring additional development (size) and focus and direction
Declining membership not encompassing all of the consultants and trainees
Declining Income from Pharma
Perceived as inward looking and comfortable, silo working
Devolved countries need more support
Membership under pressure and looking to BSR – particularly how to deal with system reform
BSR Strategic Goals
Underpinned By Raising Profile and Re-energising Membership
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Goal 1: Promote best practice and excellence in rheumatology services by:
- Support education of individuals with rheumatic diseases about their conditions and promote
involvement of individuals in decisions about their care
- Provide national audit and guidelines and supporting implementation of research in daily
practice
- Identify clinical excellence, disseminate learning and strengthen localisation through Regional
Clinical Local Networks
- Joint web site with Primary Care to promote best practice
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Goal 2: Influencing policy makers and commissioners by raising awareness of rheumatology
by:
- Build clear identity for rheumatology with leading edge service models and patient focused
pathways
- Dispersed clinical leadership through Regional Chairs
- Develop clinical measurements and contract mechanisms best suited for Long Term Conditions
- Promote national indicators and performance monitoring for continuous quality improvement
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Goal 3: A provider of high quality courses and educational resources accessible to all
musculoskeletal professionals (Be the provider of choice for education in rheumatology) by:
- Increase media coverage and communications and marketing of rheumatology
- Accelerate e-learning needed for revalidation
BSR Strategic Goals
Underpinned By Raising Profile and Re-energising Membership
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Goal 4: Diversify membership to reflect multidisciplinary rheumatology by:
- Develop closer working with BHPR, BSPAR, PCRS and RATs providing business
support services
- Strengthen European, Asia and Far East links through International Strategy
working group
- Strengthen policy input into devolved countries
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Goal 5: Diversify income streams to reduce reliance on any one source by:
- Developing a financial management strategy with a broader portfolio
- Review external opportunities through education, training and similar initiatives
- Attract new funding (eg grants from external bodies like Health Foundation)
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Goal 6: Promote interactive communication with members and the public
optimising the use of technology by:
- More interactive web site, use smart technology, regular updates to members
- Increase press coverage, further develop regions to enable local input
Defining Rheumatology for Policy Makers and
Commissioners
A multidisciplinary branch of medicine that deals with the investigation,
diagnosis and management of patients with arthritis and other
musculoskeletal conditions. This incorporates over 200 disorders affecting
joints, bones, muscles and soft tissues, including inflammatory arthritis and
other systemic autoimmune disorders, vasculitis, soft tissue conditions,
spinal pain and metabolic bone disease. A significant number of
musculoskeletal conditions also affect other organ systems.
Rheumatology is in the midst of a period of exponential growth in knowledge of
the mechanisms of rheumatological and auto-immune disease, knowledge
which is transforming and advancing our treatment options.
There is untapped potential for Quality improvement through addressing
variation in treatment and care; Innovation through implementing best
practice; Prevention of unnecessary disability and improvements in
Productivity.
Rheumatologic Long Term Conditions
within musculoskeletal services
The framework is a vehicle to inform policy makers and commissioners and to
frame research and consists of 5 domains underpinned by pathways:
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Collaborative pathways span the whole patient pathway, involve all clinicians,
and are also referred to in health policy as an integrated care pathway.
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The pathway methodology enables the differing contributions of various
clinicians along a patient pathway to be reflected along a continuum of care.
Rheumatologic Long Term Conditions Framework
Domains and Pathways
Domain
Pathway
Inflammatory
Conditions
Connective Tissue
Conditions
Rare Conditions
Diagnostics and
Pain management
Rheumatology
Bone conditions
Rheumatoid
Arthritis and
juvenile idiopathic
arthritis
Systemic lupus
erythematosus
/Antiphospholipid
Syndrome
Hereditary
recurrent fevers
Osteoarthritis
Osteoporosis
Paget's disease
Regional bone
disorder
Seronegative
Spondarthritis
disorders
Sjogrens
Sarcoidosis
Regional pain
(back pain, limb
pain, etc.)
Gout and crystal
disease
Myositis
Relapsing
polychondritis
Fibromyalgia
Infection-related
arthritis (reactive
and septic)
Scleroderma
Amyloidosis
Vasculitis and
Behcets
Rare arthropathies
Polymyalgia and
temporal arteritis
British Society for Rheumatology Dec 2011.
Hypermobility
Other
polyarthralgias
Other metabolic
bone disease
Bone dysplasias
Rheumatologic Long Term Conditions Framework
Domains and Pathways
Domains
Pathways
Rare Conditions
Connective Tissue
Diseases
Inflammatory
Arthritis /Disease
Diagnostics and
Pain management
Bone Conditions
Hereditary
recurrent fevers
Systemic lupus
erythematosus
Rheumatoid
Arthritis
Osteoarthritis
Osteoporosis
Sarcoidosis
Sjogrens
Seronegative
Arthritis
Back Pain
Paget's disease
Relapsing
polychondritis
Myositis
Reactive/Septic
arthritis
Regional pain
(upper and lower
limb pain)
Regional bone
disorder
Amyloidosis
Scleroderma
Gout/Crystal
Arthritis
Fibromyalgia
Osteomalacia
Rare arthropathies
Vasculitis
Polymyalgia
Hypermobility
Other metabolic
bone disease
Mainly secondary
care
Mainly primary
care
Patient based pathways evidence based:
Rheumatoid arthritis – example only
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1ry and 2ry
Prevention
Diagnosis
Treatment
• Anti-CCP positive
arthralgias
• History and
examination
•Early use of
DMARDs and
monitoring
•Early aggressive
treatment with
DMARDs
• Blood tests,
inflammatory
markers, serology
•Smoking prevention •Joint imaging, xrays, ultrasound
•Obesity and
exercise
Case
Joint Protocol
management with care plan
• Monitoring of CRP • Shared care for
and DAS28 monthly
until stable
established DMARDs
•Short term steroids
• Patient education
and self care
• Pain relief
• Prompt treatment
of early flares
• Annual review and
monitoring for comorbidities
•Access to specialist •Keeping people in
physiotherapy,
work and CVD risk
podiatry and OT
assessment
Indicators - examples
• Symptom onset to DMARD treatment within 3 months
• Aim for remission or at least DAS28 under 3.2
• Annual review by a specialist MDT including HAQ
• CVD risk assessment undertaken each year
Health system level patient pathway
British Society for Rheumatology Dec 2011.
• Protocols for when
rapid access to
specialist care is
needed
Regionalisation Next Steps
Ruth Richmond - Scotland
Philip Gardiner –
Northern Ireland
Clive Kelly 2012
England
Election 2012
Vacant ; Election 2012
BSR elected Council
Representative/RCP&RSA Rep
RCP RSA Representatives
Mersey
Mano George
Elections to vacancies 2012
Peter Lanyon 2012
Jonathan Packham
Richard Watts 2012
J Camilleri -
3 Regions
Wales
Joel B David 2012
Nick Viner
Gerald George
Regions
BSR members have asked for more activity at regional local level and BSR support to
local groups to enable discussion with commissioners. Part of the BSR support
requested is through service models and pathways.
Full Regionalisation in 2012
• Elections to the remaining BSR Regions will be made by May 2012 at which
point all 16 regions will have a Regional representative.
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BSR central office can offer administration support and travel expenses for
speakers
Communication
• BSR can send personalised e-mails to all members in a region from a named
individual on the Regional Group
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BSR central office can set up e-groups for each region to facilitate
communication
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Each region is encouraged to set up its own page on the BSR web site which
might include details of Regional chairs, local events
Question:
Should the Regional Representatives also have
RSA responsibility ?
It has been agreed that Regional
Representatives are developed into Regional
Chair roles; what should this cover?
Regional Groups
Roles and Responsibilities
Regional Groups
• Act as local professional focus for BSR members
• Provide a forum for identifying and sharing best practise
• Provide a forum for two way communication between BSR central office and
members
• Enhance membership engagement
• Clinical Focus CPD
• Two meetings a year, actual or virtual
Regional Chair
• Preside over all group meetings at which he or she is present and is a member of the
BSR Council
• The Chair is the main contact with BSR central office
• The Chair is responsible collating a programme of activities for the year and reports
to the BSR council
• The Chair is responsible for ensuring that communications are circulated to all group
members
Regional Local Clinical Networks;
National Context
•
Implementation in England prescribed by the NHS Commissioning Board of an
overarching Strategic Clinical Network supported by around 14 Local Clinical
Networks to be announced in March 2012 likely to include cardiac and cancer
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These are seen as ‘engines ‘ for change and pathway co-ordination across complex
systems or pathways of care’ and improving quality outcomes
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They will bring together primary , secondary clinicians together with patients to
define evidence based best practice pathways. The Chair will be a Lead Clinician.
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They will advise the commissioners who will be:
1) NHS Commissioning Board and 4 devolved regions ; specialist commissioning and
primary care (GP GMS contract) commissioning
2) CCG level ; all other commissioning
Question:
The new NHS Commissioning Board (NCB) through Medical
Director Bruce Keogh is introducing Strategic Clinical
Networks, these are mandated by the NCB but there is
also opportunity to set up informal clinical networks.
What would BSR Regional Local Clinical Networks look like?
BSR Regions Local Clinical
Networks
Next Steps
• Outputs of regional discussions to inform a paper on general
Regional roles and responsibilities
• Circulate paper for comments
• Agree at Executive
• Ask which regions would be interested in being a pilot for a
Local Clinical Network