Managed clinical networks
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Managed Clinical Networks. Dr C D Baker. Managed Clinical Networks. A new concept first described in the Acute Services Review report in 1998. Managed Clinical Networks. Definition

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Managed Clinical Networks

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Managed Clinical Networks

Dr C D Baker

Managed Clinical Networks

A new concept first described in the Acute Services Review report in 1998.

Managed Clinical Networks


“linked groups of health professionals and organisations from primary, secondary and tertiary care, working in a co-ordinated way, unconstrained by existing professional and Health Board boundaries, to ensure equitable provision of high quality clinically effective services throughout Scotland.”

NHS MEL(1999)10. Paragraph 3.

Managed Clinical Networks - core principles.

  • Managed with structure and clear roles

  • Purpose is to improve patient care

  • Evidence based work with use of SIGN and protocols

  • Outcomes and audit will be an integral part of the work.

  • A quality assurance programme is required.

  • Written annual report available to the public.

  • Networks must be multidisciplinary.

  • Patients must be involved

    • HDL(2002) 69

MCNs and policy in NHS Scotland

  • Concept underpinning Scottish system of NHS co-operation and co-ordination rather than competition and purchasing - important part of health policy.

  • Policy and strategic planning to be influenced by MCNs

  • Mandated in some key areas of national priority – CHD, Stroke, Diabetes & Cancer

Managed Clinical Networks - policy documents

  • Scottish Diabetes Framework

  • CHD & Stroke Strategy for Scotland

  • Cancer Plan Scotland

  • “Our National Health”

  • “Partnership for Care”

  • “Future Practice” (report on medical manpower in Scotland)

Local Cardiac MCNs

  • By April 2004, each NHS Board area should have a local cardiac MCN with a QA programme approved by NHSQIS.

  • These MCNs will undertake care from initial diagnosis through to chronic management. Rehabilitation and primary prevention is included as well as secondary prevention

Managed Clinical Networks

  • MCNs have already proved that they can produce benefits for patients.

  • We wish to see MCNs developed more widely

  • NHS Boards will be required to support this development

What does an MCN comprise?

  • All those involved in clinical care and management of disease specific area

  • Patients and voluntary sector

  • Manager and support

  • Lead Clinician

Work of MCN

  • Clinical work

  • Support with guidelines, protocols, training etc

  • Planning and strategy role

  • Co-ordination and quality assurance

  • Service development

Cardiac Services in D&G

What can a MCN offer?

  • Mutual support and sustaining of service

  • Voice for patients - and influence

  • Voice for clinicians in planning - locally and nationally

  • A means of identifying and addressing inequality

  • Service development and quality improvement

Managed Clinical Networks

  • Can NHS organisation or structures make any difference to patient care in the real world?

  • Have we got any evidence about clinical benefit from having a Cardiac MCN in Dumfries & Galloway?

Heart Failure Nursing Service

  • BHF funding as part of pilot scheme – 100% for 3 years (50% after)

  • 16 nurses funded – 12 England & Wales, 2 N Ireland, 2 Scotland (D&G)

  • Application from MCN for nurses to be employed and based in MCN rather than a Trust

  • Subject to external evaluation (York University) + internal audit (BHF Quality of Life + Athena LVF database based audit)

Heart Failure Nursing Service

  • To optimise management of patients with established LVF including

    • Titration & monitoring of diuretics, ACE inhibitors and beta-blockers

    • Initiation of drug treatment where agreed

    • Use of non-drug treatments (exercise, O2 etc.)

    • Referral onwards where appropriate

  • To provide professional advice and support to patients and carers (+ other health professionals)

HF Nursing evaluation

  • Formal external evaluation April 02 – December 03 by Dept of Health Sciences, York (Bob Lewin)

  • 5 (out of 6) centres involved

    • Bradford

    • Birmingham

    • Causeway

    • Dumfries

    • Leicester

    • (major teaching hosp excluded – recruitment problems)

HF Nursing evaluation

HF Nursing evaluation

Networks – help survival

  • Working across boundaries to enable service (and cardiologist) to survive in face of recruitment problems and new GP contract

  • MIs down by 29% from 2002-3 to 2003-4 – D&G with highest prescribing rate for ACEs, beta-blockers, diuretics, statins etc. in Scotland.

What’s on offer?

  • A mechanism/ tool/ opportunity to be used or ignored by clinicians and patients

  • An alternative mechanism to the internal market

  • A buffer against external private provision of core NHS services/loss of professional autonomy.

Clinical Networks

  • Individuals make a difference to patient care not structures or protocols

  • Networks need to support them and make lives easier

  • Equally it is individuals that make networks succeed and if they are not supported nothing will change

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