New challenges - new roles - new competencies Supporting primary care commissioning.

1. New challenges - new roles - new competencies Supporting primary care commissioning. Anne Gray, Commissioning Librarian NHS Milton Keynes UHMLG Conference, June 2011

2. MK Commissioning Librarian – a history • 2004-09 Outreach Librarian MK Hospital Library – training primary care clinicians / literature searches • little strategic impact ; improved knowledge not services • 2007-10 Quality MK - Health Foundation programme • Testing processes supporting whole system quality improvement which is patient centred, clinical led and evidence based • Evidence support to service redesign teams, journal clubs in GP practices and primary care teams, alerting services • 2009 PCT created Commissioning librarian post to inform commissioning (Cf Clinical Librarian) • 2010 PCT reorganisation?? UHMLG Conference, Soton

3. Commissioning Librarian • Important to align service in line with the current strategic objectives of the organisation - • Financial balance (QIPP challenge) • High quality health services • Support transition (to Clinical Commissioning Groups) • Strategic objectives have changed UHMLG Conference, Soton

4. Commissioning Librarian • Supporting pathway review and service redesign • Alerting services • Searching for information • Retrieval, selection, appraisal, summarise • Knowledge Zone: www.qualitymk.nhs.uk • Information skills training • Links to NHS library networks UHMLG Conference, Soton

5. Day to day work • No physical library (SLA with local hospital) • Open plan office with commissioners/managers • Meetings!! • Member of strategic Programme Boards (Planned Care; Unplanned Care; Mental Health, Delivering Capabilities, Stroke network, Neurological Conditions LIT) • Understand the current issues • Direct requests for evidence / examples etc • Unsolicited reports • Support the teams by highlighting relevant resources as and when appropriate UHMLG Conference, Soton

6. Products • Web portal – Quality MK Knowledge & Learning Zones www.qualitymk.nhs.uk • Hot topics, national alerting services, key resources, GP Consortia development, public health intelligence, elearning, • Local alerting services • Knowledge@lert for Commissioners • Contribute to other alerts in organisation • FYI highlighting particular resources to individuals “unlock the door” • Evidence search service – push and pull UHMLG Conference, Soton

7. Use of evidence in commissioning “Using evidence is not an open and shut case. Producing evidence to aid commissioning is not enough” Ref: The need for clarity in evidence based commissioning. HSJ 26 May 2011 p23-25 • Academic research project - observations and survey • Identified two themes • Need different forms of evidence • clinical and non-clinical • Plurality rather than hierarchy of evidence • Different types of evidence need to work together • Importance of timing • Very much reflects experience in practice UHMLG Conference, Soton

8. Plurality of evidence HSJ 26 May 2011 p23-25 UHMLG Conference, Soton

9. Very/quite important Local public health intelligence Expert advice Examples of best practice Local policies Guidelines Government pubs Benchmarking Cost effectiveness Not important/did not use General published literature Professional association guidance Management studies Academic research Management consultants Evidence used by commissioners Survey n=300 HSJ 26 May 2011 p23-25 UHMLG Conference, Soton

10. Evidence searches • Time intensive • Understand the question • Search • Read / extract / appraise • Summarise • Types of question • How have others done it? • Outcomes, KPIs, benchmarking • Data/models to support development of specifications UHMLG Conference, Soton

11. Evidence searches • Current topics include • Impact on hospital use (re)admission, OPD, A&E, community care • Self management, decision aids • Outcomes based contracting • Examples • Has anyone charged for DNAs? • Outcomes of MSK services • service specifications eg Community cardiology, MSK, Urgent Care • Predictive modelling tools • Return on Investment in telehealth/telecare • GPs in A&E departments • Why are our antenatal admissions so high? • What self care tools will we need to support our new MSK Clinical Assessment & Triage services? UHMLG Conference, Soton

12. Example: MSK CATS spec. UHMLG Conference, Soton

13. Search results included • Anticipated case mix based on audit from existing service • MSK self care resources • MSK patient decision aids • ALSO • Indication of impact on referral to acute care • Contact info UHMLG Conference, Soton

14. Measuring impact • Difficult to quantify • Literature search impact survey – small pool of requestors • But • Librarians are “pollinators” – Prof Paul Glazsiou • http://www.qualitymk.nhs.uk/default-ContentID-3011.htm UHMLG Conference, Soton

15. Nothing stands still • Evidence required by commissioners will not change, but the environment will • Clinical Commissioning Groups (GP Consortia) • NHS Commissioning Board – national and regional • PCT Clusters • Public Health England • NHS Evidence • Quality MK www.qualitymk.nhs.uk • PCT website – future? UHMLG Conference, Soton

16. Thank You Anne Gray Commissioning.librarian@miltonkeynes.nhs.uk UHMLG Conference, Soton