Co-Creating Health (CCH) in NHS Ayrshire & Arran

1. Co-Creating Health (CCH) in NHS Ayrshire & Arran November 2011

2. Ayrshire & Arran • Population of around 367,000 • Geography • rural • towns • islands • >8000 people living with COPD ISLE OF BUTE GLASGOW Largs Kilmarnock ISLE OF ARRAN Irvine Ayr Girvan

3. Aim of CCH in Ayrshire & Arran To enable people with long term conditions to feel empowered, confident and supported to manage their condition in a way that improves their health and well being, whilst demonstrating quantifiable benefits to the healthcare system

4. CCH Implementation • Phase 1 focus • Chronic Obstructive Pulmonary Disease (COPD) • Implementation of 3 CCH workstreams • Sharing learning and experience with other CCH sites • Phase 2 focus • Developing sustainable approaches • Spread to other conditions • Evaluating impact of CCH on service utilisation • Continue to share learning and experience with other CCH sites

5. CCH Workstreams Patient Self-Management Programme Clinician Advanced Development Programme Service Service Improvement Programme ‘White light’

6. Clinician Development Phase 1 • Advanced Development Programme (ADP) • Identified challenges to recruitment and sustainability • 3 x 4 hour sessions – time constraints • Format of ADP – inflexible and not locally relevant • Required Facilitator input unsustainable • Local geography Phase 2 • Alternative clinician training options developed • Flexible, accessible, integrated, affordable, for example; • eLearning module • Integrated into routine AHP and Nurse study days • Practice Based Small Group Learning (PBSGL)

7. Clinician Development

8. Patient Self-Management Programme Phase 1 • Original CCH Condition-specific (COPD)Self-Management Programme (SMP) • 7 x 3-hour group sessions delivered in consecutive weeks • Co-delivery by trained clinician and lay person • Identified challenges to recruitment, retention & sustainability • Recruitment to be systematic, routine part of care • Retention rate around 60% - how to improve this? • Group approach not for everyone? • Inefficiency of condition-specific model for spread to other long term conditions • External tutor training and revalidation unaffordable in longer term

9. Patient Self-Management Programme Phase 2 • Aim to develop flexible, accessible, integrated, affordable and sustainable options • ‘Moving on Together(MoT) - local patient self-management toolkit developed and introduced • Exploring alternatives to group approach e.g. patient workbook, buddy scheme

10. Patient Self-Management Programmes • Total number registered = 284 • Total number started programme= 256 • Total number completed programme = 156 • Completion rate = 61%

11. Service Improvement Focus on integrating three core processes (‘enablers’) into systems to support patient self-management

12. Service Improvement Examples • Agenda setting prompt on appointment letters • Agenda setting sheets • Goal setting aids • Clinician 6 A’s prompt sheet • Telephone follow-up • Shared communication from Consultant to GP and patient • Integration of 3 enablers in pulmonary rehab pathway paperwork • Electronic prompt in GP IT system

13. Service Improvement Examples

14. Impact of Service Improvements • 10 patients per month asked to answer 4 questions following consultation with a clinician who has participated in the CCH clinician development programme • Do you have sufficient information to manage your condition? • Do you feel supported to manage your condition? • Are you able to make decisions affecting your condition? • How confident do you feel in managing your condition on a scale 1-10?

15. Impact of Service Improvements • Patient survey results from 5 teams who have made service improvements to support self-management

16. Successes • High level engagement from outset and continued support • Fit of CCH with national and local priorities has been beneficial • Opportunities taken to integrate CCH with other related initiatives and in organisational systems/processes • Range of clinicians from primary and secondary care completed clinician programme • Patient feedback and stories demonstrate benefits and improved relationship with clinician • Developed sustainable clinician development training options • Developed local patient programme that can be easily extended to other long term conditions • Engagement with other conditions in CCH2 – Heart Disease, Diabetes, Parkinson’s

17. Challenges • Culture change needs continued effort • Gaining engagement from clinicians who consider they ‘already do’ supported self-management or who are sceptical of it • Implementing CCH as integrated model • Improving retention rates for patient programme • Alternative options to group approach for patients • Demonstrating quantifiable benefits of CCH

18. Key Messages • Vital to have commitment from key and influential leaders in organisation – Executive, Clinical and Managerial • Significant culture change needed – needs ongoing and collective effort • Full effect of supporting self-management not known for a number of years • Significant amount of dedicated time required for a core team to manage and implement CCH • Clinician training options need to be relevant and sufficiently flexible to gain interest and commitment • Implementing CCH within teams is preferable – shared learning and support

19. Key Messages • Financial incentives to gain General Practice engagement helpful, but does not guarantee it • Service improvement element challenging, but integral to continuous clinical improvement - most relevance and success when improvements identified by teams themselves • Automated prompts for clinicians to refer patients to programmes are helpful • Patients more likely to participate if encouraged by their clinician • Integrating self-management support in patient pathway from diagnosis onwards most likely to have best success over time • Sustainability prospects will improve where self-management support becomes a routine part of healthcare ‘just the way we do things’

20. Questions?