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Establishing a Managed Care Network for Hepatitis C. Justin Schofield Hepatitis C MCN Manager NHS Greater Glasgow & Clyde. Introduction. Aim: Provide overview of the process for establishing a hepatitis C MCN Content: MCN core principles Management arrangements Identify stakeholders

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Establishing a managed care network for hepatitis c

Establishing a Managed Care Network for Hepatitis C

Justin Schofield

Hepatitis C MCN ManagerNHS Greater Glasgow & Clyde


Introduction
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?


Definition
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


1 core principles

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


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


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


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


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


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


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


7: Quality assurance

MCN Accreditation Timetable: Yrs 1 & 2


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



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