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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
slide5
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
slide6
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

slide7
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

slide8
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
slide9
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
slide10
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

slide11
7: Quality assurance

MCN Accreditation Timetable: Yrs 1 & 2

slide12
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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