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PbR : Ideas from local implementataion. Dr Pratima Singh Strategic Clinical Leadership fellow NHSL& Oxleas FT. Background. Clinical lead for PbR in Oxleas NHSFT London Fellow in Strategic clinical leadership NHSL Deputy to Dr Strathdee, AMD NHSL and London SHA lead National input

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Pbr ideas from local implementataion

PbR : Ideas from local implementataion

Dr Pratima Singh

Strategic Clinical Leadership fellow NHSL& Oxleas FT


Background
Background

  • Clinical lead for PbR in Oxleas NHSFT

  • London Fellow in Strategic clinical leadership NHSL

  • Deputy to Dr Strathdee, AMD NHSL and London SHA lead

  • National input

  • Regional

  • Local

  • Joint working with Devon , Avon, Solent healthcare, CNWL


Pbr projects undertaken
PbR projects undertaken

  • MHCT trainer and PbR Lead for Care Package Development

  • Audit of Current care PbR clusters (n=126)* Poster

  • Deep dive into understanding variation in lower clusters 1-3 (n=600+) and 11-17 ( n=1000+)

  • Evidence based care package development for 1-21 based on above with clinical group*



CLUSTER xyz CARE PACKAGE ELEMENTS IN OXLEAS NHS FOUNDATION TRUST

Core Elements of Care:

QUALITY AND OUTCOMES GOALS

ENTRY TO OXLEAS SERVICES

Common referral sources:

Assessment:

Cluster Description:

CRISIS MANAGEMENT

CARE COORDINATION

MONITORING OF PHYSICAL AND MENTALHEALTH

Diagnoses:

Risk :

Course:

Expected Needs

Indicative episode of care: Cluster reviews at least every:

Step up criteria: Step down:

Case Contingent Elements of Care:

DISCHARGE CRITERIA (eg)

Collaborative Working with agencies to meet


Key findings
Key findings PACKAGE ELEMENTS IN OXLEAS NHS FOUNDATION TRUST

  • Variation of patient profiles wide within each cluster ?

  • Variation between cluster allocation by clinician and MHCT booklet Clusters 1-3: Upto 57% ,Clusters 11-17: Upto 55% * Importance of getting this first basic step right.

  • Overlaps and exclusions

  • Inconsistency of recording clinical information and lack of feedback of information to clinicians

  • Gaps between actual and proposed care packages- very wide even between clinicians, teams, boroughs


Way forward
Way Forward PACKAGE ELEMENTS IN OXLEAS NHS FOUNDATION TRUST

  • Quality of cluster allocation and Link with a care package

  • Use existing NICE core interventions as frame work of Care packages that can be audited

  • Developing common language of beds, interventions to understand care packages

  • Link MH MDS data to outcomes I- ICD10, accommodation, crisis/acute/rehab/HTT beds

  • Commission a 1in 10 audit sample to check Cluster appropriation and Care Packages that follow* tool


Thank you PACKAGE ELEMENTS IN OXLEAS NHS FOUNDATION TRUST


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