Map Of Medicine

1. Dr Andrew O'Brien Islington CCG Map Of Medicine

3. Islington • Most densely populated local authority in England and Wales • Population of 206,100 (Census 2011) over 14.86km² • 34% of population born abroad and 26.1% BAME • 57% of population under 35 • Paradoxically Islington ranks within the top 20 of most prosperous boroughs in the country (Local Future 2010) whilst at the same time being ranked as the 8th most deprived boroughs nationally in 2010

4. Data Source – ONS – Life Expectancy for local areas in England and Wales 2008-2009. NHS ISLINGTON. June 2010. Closing the Gap, Tackling Health Inequalities in Islington. Source - Paper 2: Health Inequalities in Islington. The Islington Fairness Commission

6. Context • Number of 1st outpatient appointments in Islington rising • Variation exists in management of patients between practices in the borough • Large number of local services and providers and very difficult for primary care clinicians to be kept abreast of these • Referral management centre approach not locally palatable

7. Why the Map of Medicine? • One stop source of local and international clinical guidelines • Directory of local services • Communication Tool – e.g. Contact Details & Waiting Times • Potential for being a central repository of referral forms • Ensure patient seen by right service at the right time using the right form… and help CCG to meet QIPP savings in process

8. Story so far.. • Negotiations and preliminary work commenced April 2013 • Initial local pathway development began August 2013 • ‘Familiarisation Event’ took place 26th September 2013 • Map ‘live’ in Islington October 2013 with 26 local pages published

9. Story so far.. • Training of all 37 local practices completed between October 2013 and January 2014 • Currently 64 pages of localised content have been published and on course for 100 page target by end of October 2014 • Testing of auto-population of referral forms currently on-going in parallel with collation of all referral forms to create central repository of referral forms

10. Engaging with stakeholders • Practices – Use and take up of tool tied in with the GMS contract via QP markers. Points gained by: • Attending the Familiarisation Event • Configuring (setting up) the tool for each user (50% of clinicians must have logged on since launch to qualify) • Utilising the training offered to practices • Completion of survey at end of QOF year • Further event for MoM for GPs planned for December 2014 with new LCS incorporating engagement with MoM & regular updates via GP Bulletin and education events

11. Engaging with stakeholders • Providers • Engagement with secondary care clinicians in creation of pathways via working groups • Empowerment of providers to edit local information to improve maintenance of local content • Stakeholder event (Providers and Neighbouring CCGs) planned for September 2014 • Consideration of adding engagement with MoM in contracts

12. Develop Map of Medicine versions for local pathways already in development Adapt existing local pathways and service information for the map Work with Providers, 3rd sector, GPs and Patients to identify and develop new pathways and content for the map Generating Content

13. Generating Content • Small core team of Project Co-ordinator, administrator and Clinical Lead • Training on map editing delivered to all of primary care team, members of medicines management team, joint commissioning (mental health & children’s services), CSU and Public Health team • Use of Map Editor to design and edit pathways live during meetings with clinicians present

14. ICCG MoM Governance Structure

19. Published Local Maps • Clinical Pathways • Hepatitis Pathways – • HBV and HCV Testing • HBV vaccination • Management of Hep B sAg +ve • Management of HCV RNA +ve • Paediatric Pathways – • Acute Wheezy Episode (2-5 yrs) • Acute Asthma Attack - Management for known asthmatic Children (5-18 yrs) • Constipation in children & young people • Epilepsy • Weight management (4-17yrs) • Reflux • Allergies in Children • Diabetes Pathways– • Glycaemic Control • Oral anti diabetic agents • Vitamin D Pathways • Vitamin D Deficiency in Children • Vitamin D Deficiency in Adults • Ophthalmology • Low Vision Service • Respiratory • COPD • Acute exacerbation of COPD • Oxygen Prescribing • Smoking cessation • COPD prescribing guidelines

20. Published Local Maps • Mental Health • Mental Health Services • Substance Abuse Pathways • Locally commissioned direct access mental health services in voluntary sector • Community Services • Physiotherapy & Podiatry referral forms & waiting times • District Nurse Service Structure & Contact Details • Locality Navigators • Medicines Optimisation • Antimicrobial Guidelines • Erectile Dysfunction (Prescribing) • Management in Undernutrition in Adults (MUST) • Prescribing Guidelines • Referral information & Criteria • DVT referral pathway • PoLCE guidelines

24. Referral Guidance

25. Form Directory

26. Usage

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39. Challenges • Keeping it relevant and up-to-date • Generating more content whilst maintaining quality & control • Overcoming IT barriers to usage • Proving impact • Keeping GPs and providers engaged

42. Still work in progress... come back in 6 months for clearer answer

43. Thank You • Dr Andrew O'Brien • andrew.obrien@islingtonccg.nhs.uk