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

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Map of medicine

Dr Andrew O'Brien

Islington CCG

Map Of Medicine


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


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


Context England and Wales 2008-2009.

  • 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


Why the Map of Medicine? England and Wales 2008-2009.

  • 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


Story so far.. England and Wales 2008-2009.

  • 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


Story so far.. England and Wales 2008-2009.

  • 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


Engaging with stakeholders England and Wales 2008-2009.

  • 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


  • Engaging with stakeholders England and Wales 2008-2009.

    • 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


    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


    Generating Content in development

    • 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


    ICCG in development

    MoM Governance

    Structure


    Published Local Maps in development

    • 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


    Published Local Maps in development

    • 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


    Referral Guidance in development


    Form Directory in development


    Usage in development


    Usage in development


    Feedback in development


    Feedback in development


    Feedback in development


    Feedback in development


    Feedback in development


    Feedback in development


    Feedback in development


    Feedback in development


    Feedback in development


    Feedback in development


    Feedback in development


    Challenges in development

    • 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


    Still work in progress... in development

    come back in 6 months for clearer answer


    Thank You in development


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