Shared Decision Making – No decision about me, without me

1. Shared Decision Making –No decision about me, without me Kim Teasdale and Sam Hood Commissioning Managers South Tyneside and Gateshead CCGs kim.teasdale@sotw.nhs.uksam.hood@sotw.nhs.uk

2. STCCG - What did we do and why? • Shared Decision Making key component of our Referral Improvement Scheme (RIS) for 2012/13 – Demand Management project working with our GP practices to improve the quality of their referrals • System pressures around elective activity particularly OP appointments in 3 specialities - General Surgery, Orthopaedics and Gynaecology – and focussed on 6 specific conditions within these • Used SDM as a tool with the clinical teams to drive up the quality of GP referrals • SDM is best practice and as a CCG we wanted to build it into our clinical culture and practice in South Tyneside

3. Referral Improvement Scheme (RIS)

4. How did we implement Shared Decision Making?

5. Outcomes • Better management of patients with these conditions – more confident GPs with more satisfied patients (questionnaire) • Financial savings of around £500k in 1st OP attendances for those 3 specialities • Engagement with secondary care to adopt similar practice – early stage involvement in top tips / BDA development etc.

6. Next steps..... • Advanced consultation skills - continuing to train GP trainer and embed in training culture in South Tyneside • READ coding of MAGIC consultations with practice continuing promotion • Developing SDM skills into Supported Self Management as part of our Improving Care Scheme for 2013/14 (STICS)

7. Why SDM? Opportunity to improve the quality of consultations in Primary Care Improve quality of referrals Improve outcomes for patients Increase patient engagement in their care – “no decision about me without me” Add value to the Q&P QOF process for practices through training in a new skill – SDM SDM ethos ties strongly with GCCG vision and values Improve patient experience of care

8. How? • 2013/14 Quality &Productivity element of Quality and Outcomes Framework (QOF) indicators, applied to secondary care outpatient referrals (Q&P 1 – 3) • Encouraged use more widely within general practice than just Q&P QOF • Worked with the Newcastle SDM Team to put in place training for all Gateshead General Practices • Training of CCG Core team and Executive GPs • General awareness training July 2013 TITO locality meetings • Shared Decision Making Skills Workshops September 2013 TITO – at least 2 GPs from each practice to attend • Practice Nurse Workshops September TITO • and September Diabetes Masterclass

9. Outcomes • 68 GPs from 33 practices trained in SDM • 2 x Practice Nurse workshops held focusing on SDM in LTCs • Some GPs would like further training on practical application in consultations • Positive response from Practice Nurses • Practice Managers keen to begin to use Ask 3 Questions materials in their practices

10. Learning from implementation to date • Support from CCG Executive GPs crucial to success so far • Difficulty in training GP trainers locally • Practice Nurse Trainers more success locally • SDM v Pathway approach • Practice Managers interested – links to patient participation, benefits for CQC inspections

11. Future • Evaluate uptake of SDM at end of March 2013 • Role out Ask 3 Questions materials to practices • Look at how we can embed in Gateshead beyond 2013/14 and Q&P QOF • Issues to tackle • How do we know it’s made a difference to patients and empowered them? • Once SDM team disbanded how do we grow our own support – particularly amongst GPs? • Changing culture of General practice and patients to change their relationship with each other • Evaluating impact on health system

12. Thank you