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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. 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

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  1. PbR : Ideas from local implementataion Dr Pratima Singh Strategic Clinical Leadership fellow NHSL& Oxleas FT

  2. 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

  3. 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*

  4. 7 Cardinal Basics of Every NICE Guideline

  5. 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

  6. Key findings • 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

  7. Way Forward • 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

  8. Thank you

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