Establishing a Managed Care Network for Hepatitis C

1. Establishing a Managed Care Network for Hepatitis C Justin Schofield Hepatitis C MCN ManagerNHS Greater Glasgow & Clyde

2. Introduction Aim: Provide overview of the process for establishing a hepatitis C MCN Content: • MCN core principles • Management arrangements • Identify stakeholders • Map patient journeys • Annual work plan • Service standards • Quality assurance • Risks & potential benefits • Phase II Action Plan • Evidence • Strategic direction • Investment • Cross-cutting priorities & actions • HepatitisC MCN • Co-ordinated approach to service development • New ways of working • Improve service to patients • Health Boards & partners • Where to start? • Who to engage with? • How to manage process?

3. Definition • A Managed Care Network is: • A linked group of health professionals & organisations, • working in a co-ordinated manner, • unconstrained by existing professional andorganisational boundaries, • to ensure equitable provision of high quality, clinically effective services. Scottish Executive MEL(1999)10 http://www.mcn.scot.nhs.uk/pdf/mel199910.pdf

4. Management arrangements Lead Clinician Network Manager Structure Patient pathway Annual work plan Activities Outputs Benefits to patients Annual report Evidence base SIGN Clinical audit & research findings National & local evidenceof need 1: Core principles • Membership • Multi-disciplinary & multi-professional • Patients & vol. sector • Supported to enable meaningful participation • Quality Assurance • MCN accreditation • Clinical governance, audit, risk management, patient safety • Education & training • Continuous professional development • Internal & external to MCN • Value for money • Evidence that this has been explored • http://www.nhshealthquality.org/nhsqis/files/HDL2007_21.pdf

5. National forums National Hepatitis C Executive Leads Group (in existence) 2: Management arrangements • Lead Clinician • “… overall responsibility for the functioning of the Network” HDL(2007)21 • Reflect role in Job Plan • MCN Manager / Co-ordinator • Support Lead Clinician • Project management • Effective working relationships: • Within MCN • Upwards to Health Board • Across external organisations • Hep C Executive Lead • Responsible for implementationof Action Plan • Prevention • Testing, treatment, care & support • Co-ordination • Training, education & awareness raising • Budget-holder • Strategic overview National Hepatitis C MCN Clinical Leads’ Group (in development) • Share information, learning, resources & best practice • Avoid duplication of effort • Agree national standards • National co-ordination & performance monitoring • Communication with HPS & Government

6. 3: Identify stakeholders Testing & Referral Health Board Drug Services Primary Care Prison PublicHealth HealthImprovement Public / Patient Involvement Finance Training BBV Prevention GUM Maternity Services Inpatients Planning CHPs Other MCNs Specialist Care • Stakeholders • Strategic or operational? • Internal or external to MCN? • Actively involved or kept informed? • Patient Involvement • Orgs. that advocate on behalf of people living with & at risk of HCV • Directly with patients & clients • Stakeholder analysis informs: • MCN structure & membership • Communication strategy • Ultrasound • Dietetics • Psychology • Psychiatry • Laboratory • Pharmacy • Service Mgrs InfectiousDiseases Hepatology Gastroenterology Care & Support PrimaryCare SocialCare DrugServices Prison Vol. Sector MentalHealth

7. 4: Map patient journeys Testing & Referral • Identify • Key service providers • Available resources • Patient & information flows • Barriers along journey • Service pressures • Gaps = opportunities for development • Available evidence • Phase II Action Plan • Surveillance data (HPS) • Clinical database • People with HCV • Service providers knowledge • Agree priorities • Inform annual work plan • Proposed developments • Associated investment DrugServices Primary Care Prison People & information GUM MaternityServices Inpatients Specialist Care • Ultrasound • Dietetics • Psychology • Psychiatry • Laboratory • Pharmacy • Service Mgrs InfectiousDiseases Hepatology Gastroenterology Care & Support PrimaryCare SocialCare DrugServices Prison Vol. Sector MentalHealth

8. 5: Annual workplan MCN Development Service Developments • Communications • Web site • Communication withstakeholder groups • Annual report • Membership & Structure • Bring key stakeholdersinto process • Subgroups e.g. • Prison liaison • Outreach testing & referral • Public & patient involvement • Uni-professional groupings • Clinical audit • Quality Assurance • MCN accreditation • Treatment protocol • Clinical audit • Priorities informed by • National Action Plan • Local mapping • Define activities, outputs,& benefits to patients • Develop infrastructure • Clinical staff resources • Outpatient clinic space & locations • Outreach staff & settings • Agreement with partner agencies • Pilot / launch developments • Monitoring arrangements • Activities • Outputs • Outcomes • User satisfaction

9. 6: Service standards • Accountability and organisation • Policies and procedures • Testing • Specialist referral • Management and treatment • Care and support • Collaboration and partnership working • Patient information and awareness-raising • Education and training • Monitoring, evaluation and audit • Used to asses MCN performance • Sound evidence base, • Clinical & care issues, • Relate to the objectivesof the MCN, • Clear and measurable, • Follow the patient pathway, • Consistent with those for other hepatitis C MCNs across Scotland. • National standard for hepatitis C services • Phase II Action Plan – Action 2 • To be developed by QIS &national MCNLeads Network • Due 2010 • Phase II Action Plan accompanied by draft guidelines for hepatitis C MCNs • Inform service standards • National & local

10. 7: Quality assurance • MCN Accreditation • NHS Board accredits local MCNs • Existing process & support • MCN must demonstrate: • Plan to implement core principles • Service standards developed • Monitor implementation of core principles & standards • Reporting arrangements in place • Process for implementing recommendations • QIS Quality Assurance toolkit* • Overview • Guidance • Templates * Toolkit provided with this presentation

11. 7: Quality assurance MCN Accreditation Timetable: Yrs 1 & 2

12. Risks and benefits risks benefits • Lack of corporate buy-in • Threat to clinical autonomy • Resistance to change • Range of organisations with own pressures & priorities • Bureaucracy • Inertia • Organisational capture by dominant partner • Tokenistic user involvement • Integrated patient care across professional & organisational boundaries • Equitable service provision • Reduce duplication of effort& resources • Best use of scarce resources • Innovation • Patient-centred services • Development opportunities for staff

13. Key messages