DELIVERING PCI THROUGH THE CLINICAL NETWORK

1. DELIVERING PCI THROUGH THE CLINICAL NETWORK DR JIM HALL THE JAMES COOK UNIVERSITY HOSPITAL MIDDLESBROUGH

4. NHS Plan/ Modernisation Agenda Clinical Governance CHAI National Service Framework CHD NICE PCI EVIDENCE BASED PRACTICE Performance Management & Framework PATIENT CHOICE

5. NHS Plan/ Modernisation Agenda Clinical Governance CHAI National Service Framework CHD NICE PCI CHD Networks EVIDENCE BASED PRACTICE Performance Management & Framework PATIENT CHOICE

7. CHD NSF • NETWORKS OF CARDIAC CARE • “The usual model will involve linking tertiary cardiac centres, cardiac units in district hospitals and primary care. Typically the geographical boundaries of a network will match those of the PCTs whose populations are served by the relevant tertiary centre. The network should agree common referral criteria, treatment protocols etc”

8. NEWCASTLE SUNDERLAND DURHAM HARTLEPOOL BISHOP AUKLAND MIDDLESBROUGH WHITEHAVEN NORTH TEES DARLINGTON NORTHALLERTON

9. CATCHMENT POPULATION TEESSIDE 550,000 COUNTY DURHAM 612,000 NORTH YORKSHIRE 158,000 CUMBRIA 238,000 • TOTAL POPULATION ~ 1.5M

10. CHD NSF • PCI CAPACITY • Revascularisation waiting times • PCI • 3 months maximum

11. CHD NSF • PCI CAPACITY • Revascularisation waiting times • PCI • 3 months maximum ? 750/million

12. PCI and CABG rates per million in European countries in 2000

13. PCI JCUH

14. PCIRATES PER MILLION JCUH

15. PCIRATES PER MILLION JCUH

16. NORTH OF ENGLAND COAST TO COAST CHD NETWORK • ‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’ • the patient’s journey predominates (the family test)

17. NORTH OF ENGLAND COAST TO COAST CHD NETWORK • ‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’ • ‘CHD Collaborative embedded within the network’ • ‘commissioning advisor to the PCO’

18. NORTH OF ENGLAND COAST TO COAST CHD NETWORK • ‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’

19. NORTH OF ENGLAND COAST TO COAST CHD NETWORK • ‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’ • PCT Trust Ambulance • LA WDC LITs SHA • CHDC PCC BHF

20. NORTH OF ENGLAND COAST TO COAST CHD NETWORK • ‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’

21. NORTH OF ENGLAND COAST TO COAST CHD NETWORK • ‘to facilitate the delivery of the NSF for CHD and the NHS National Plan’ sub-groups - • commissioning/performance • clinical • CHDC

22. NORTH OF ENGLAND COAST TO COAST CHD NETWORK • REGIONAL REVASCULARISATION STRATEGY • NETWORK ANGIOGRAPHY STRATEGY • NETWORK ICD STRATEGY

23. NORTH OF ENGLAND COAST TO COAST CHD NETWORK • Clinicians sub-group • ACS guidelines • emergency PCI guidelines • ICD guidelines

26. NORTH OF ENGLAND COAST TO COAST CHD NETWORK • ‘commissioning advisor to the PCO’ • no direct commissioning role • not a managed clinical network

27. NORTH OF ENGLAND COAST TO COAST CHD NETWORK • NEW DEVELOPMENTS • Drug eluting stents - approx £1.6m if used in all 1500 projected cases • GP IIb/IIIa • ASD closure • new thrombolytics • RFA ablation of AF • biventricular pacing • others

28. NORTH OF ENGLAND COAST TO COAST CHD NETWORK • CHALLENGES • better links with PCTs • better links with StHA • better links with DoH • does this need a more formal structure cf collaboratives

29. CAPTAIN JAMES COOK 1728-1779

30. CHD NETWORKS • not perfect • not the finished article • accountability • performance management • clinical governance (?peer review) • managed clinical networks

31. NHS Plan/ Modernisation Agenda Clinical Governance CHAI National Service Framework CHD NICE PCI CHD Networks EVIDENCE BASED PRACTICE Performance Management & Framework PATIENT CHOICE