Shared Decision Making (SDM) – about the national programme

1. Shared Decision Making (SDM) – about the national programme • Part of QIPP Right Care programme – headed by Dr Steven Laitner, GP and national lead for Shared Decision Making • Builds on work of NHS Direct and others to develop and publish decision aids (see http://www.nhsdirect.nhs.uk/DecisionAids) • Key focus of this phase of the programme is to: • Develop and produce decision aids for a further 16+ topics, to deliver a technical solution and to provide a decision coaching service – led by Totally Health plc, with support from BMJ Evidence • Embed Shared Decision Making in systems and commissioning processes and to carry out a programme evaluation – Capita Health • Develop a culture of Shared Decision Making - AQUA

2. Patient Decision Aids – existing and proposed topics Existing PDA’s available on NHS direct: • Advanced kidney disease • Benign prostatic hyperplasia • Cataracts • Localised prostate cancer • PSA testing • CVS and amniocentesis • Breast cancer • Knee arthritis • Osteoarthritis of the hip • AQUA to focus cultural change programme on 3 pathways: renal, MSK and maternity (collaborative) and on whole system approach (social movement)

4. Patient decision aids: this year’s programme Rewrite NHS Direct Core topics Additional topics

5. SDM – snapshot of progress on implementation locally • NHS North West – commissioned Picker to explore views of SDM amongst local health economies, stakeholders and patients. Report identified systems and structures that would be required to establish ‘shared decision-making as the norm’ in the patch • Solent NHS Trust and Nuffield Orthopaedic Centre NHS Trust – tested the PDA for OA of the knee in practice with patients who had recently confirmed diagnosis. Demonstrated benefits around access to information, particularly when used with clinical support • Herts Valley Clinical Commissioning Group – focussed on developing clinical and staff perspectives of SDM and information giving, within individual practices and the Commissioning Strategy. • Southend Estuary Clinical Commissioning Group – identified what a patient-engaged organisation looks like and how it might be delivered. The focus of the project lay principally with primary care and with the emerging clinical commissioning organisations. • South Norfolk Healthcare – tested an organisations ability to introduce Shared Decision Making (SDM) and the use of Patient Decision Aids (PDAs) to member practices and patients.

6. What we’re looking for … • An innovative, forward thinking health economy (CCG and possibly provider organisations) interested in Shared Decision Making • Some understanding of local priorities, commissioning processes and any relevant process improvement initiatives – so we can design a programme that meets local demands as well as what we’ve been commissioned to do nationally • Real, practical engagement with local commissioning processes and systems • Potential opportunities for collaboration on research and evaluation at a local level

7. Our objectives • To develop a framework and methodology for future NHS commissioning bodies to promote SDM and usage of PDAs within their health economy • To recruit two local health economies and work closely with them to test out the framework and methodology and to effect system change, working with specific clinical pathways (as agreed with local health economies) • To develop a matrix for specific clinical pathways, identifying for each PDA the likely relevant patient decision points and the relevant professional groups involved in the pathway, e.g. GPs, midwives, advanced practitioners • To capture learning from our local activity in order to support successful wider implementation, with a particular focus on commissioning systems and processes, clinical pathways and the informed consent process • To identify national levers (such as standard contracts) and work with the Department of Health and other relevant bodies to effect change

8. Why should health economies be interested? • National policy priority: White Paper, information strategy, QIPP, legislation • Research evidence shows that implementing SDM can support demand management and reductions in variation of intervention - local link to procedures of limited clinical value (PLCV) • Informed patients likely to be more satisfied • Opportunity to shape guidance to be issued by Commissioning Board, emerging policy and Patient Decision Aid tools themselves • Support to be provided by Capita commissioning experts, working with local health economies on priority areas e.g. MSK pathway • For further reading, look at this Kings Fund report by Angela Coulter and Alf Collins http://www.kingsfund.org.uk/publications/nhs_decisionmaking.html