Dr Anne Talbot GP & Urgent Care Clinical Lead, Bolton CCG

1. Supporting urgent care using clinical dashboards: transforming data into knowledge Dr Anne Talbot GP & Urgent Care Clinical Lead, Bolton CCG Associate Medical Director, Service Transformation, Greater Manchester

2. Presentation Overview • An overview of the Urgent Care Clinical Dashboard concept (including dashboard screenshots) • The local implementation approach • The project’s current position • Benefits • Success factors and key messages

3. The Urgent Care Clinical Dashboard Concept • The dashboard collates the previous day’s urgent care activity data and brings it all together in a user-friendly graphical display, integrated with GP practice data • GP practice staff may access the dashboard on their desktops via secure login. District nurses and active case managers can be given access for practices they work with • Clinicians can drill down to a more detailed patient-level view • Each dashboard is clinically-driven and locally led. Sites can use existing technology to build their dashboard, keeping costs down and increasing flexibility

4. Integrating sources of information Information From Acute Trust Walk in CentrePatient Attendance DatePatientM 01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012PatientJ04/09/2012 A&E AttendancesPatient Attendance DatePatientA 01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012PatientJ04/09/2012 PatientK03/09/2012 Information received separately from multiple sources within different time frames – making identifying patterns difficult PatientK 03/09/2012 PatientK08/09/2012 Out Of HoursPatient Contact DatePatientT 01/09/2012 PatientY 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012PatientJ04/09/2012 AdmissionsPatient Admission DatePatientA 01/09/2012 PatientH 04/09/2012 PatientK08/09/2012 PatientK02/09/2012 DischargesPatient Discharge DatePatientA 08/09/2012 Information From Practice PatientK08/09/2012 Practice Disease RegisterPatient RegisterPatientT Diabetes PatientS CHD PatientK COPD Before the Dashboard

5. Integrating sources of information WiC WiC Patient Attendance DatePatientM 01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012PatientJ04/09/2012 Information From Acute Trust Dashboard:Patient Drilldown - PatientK A&E A&E A&E Patient Attendance DatePatientA 01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012PatientJ04/09/2012 PatientK 02/09/2012 PatientK 03/09/2012 COPD OOH OOH Patient Contact DatePatientT 01/09/2012 PatientY 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012PatientJ04/09/2012 PatientK 08/09/2012 COPD Admission Admission Patient Admission DatePatientA 01/09/2012 PatientH 04/09/2012 COPD PatientK 03/09/2012 COPD PatientK 08/09/2012 COPD Information From Practice COPD Discharge Discharge Patient Discharge DatePatientA 08/09/2012 Practice Disease RegisterPatient RegisterPatientT Diabetes PatientS CHD PatientK 08/09/2012 PatientK COPD

6. The original Bolton dashboard

7. Devon dashboard

8. Cambridgeshire dashboard

9. Brighton & Hove dashboard

10. Brighton & Hove dashboard – risk

11. Brighton & Hove – drilldown

12. How Bolton use the dashboard • Individual patient level • Practice operational level - identifies issues of primary care access • Locality operational level - identifies poor patient pathways, areas of training need across professional groups • Locality strategic level - tool linked to strategic aims, objectives and plans; A&E frequent attender initiative, hospital readmission initiative, public media campaign

13. Dashboard-enabled change; practice level

14. Locality level; A&E attendances over time

15. Bolton CCG readmission initiative • Practices were asked to use the Clinical Dashboard to identify all their discharges, contact these patients within 48 hours of discharge and follow up on any problems identified. • 29.8% reduction in 24 hr readmissions • 15.5% reduction in 48 hr readmissions • Positive patient feedback

16. Implementation approach

17. Implementation approach • Structure provided to local teams through an implementation guide and toolkit available on NHS Networks. This provides templates, guides, standard metrics, data feed specifications to enable rapid progression. • Early checks to ensure that key elements for a successful implementation are addressed. These include: • clear clinical leadership and engagement with the GP community; • assessment of the technical landscape and approach for sourcing data and delivering the dashboard; • Information Governance approach; • and the creation of the clinical group to review and agree the metrics for inclusion on the dashboard

18. Typical urgent care metrics This is supported by a number of drill down views to enable clinicians to see patients’ details, the nature of urgent care contacts and supporting information like risk scores (from a risk stratification module) and disease register information.

19. Dashboard implementation sites NHS Bolton South Cheshire and Vale Royal GP Commissioning Consortia NHS Merseyside (NHS Liverpool, NHS Halton & St Helens, NHS Knowsley, NHS Sefton) NHS Manchester NHS Central Lancashire Lancaster Morecambe Carnforth & Garstang CCG NHS Oldham NHS Tameside & Glossop NHS Trafford NHS Tees (NHS Hartlepool, NHS Middlesbrough, NHS Stockton-on-Tees, NHS Redcar & Cleveland) NHS Gateshead NHS County Durham and Darlington NE Lincolnshire Care Trust Plus and partners NHS Calderdale NHS Northamptonshire NHS Leicester City, NHS Leicestershire County and Rutland NHS Cambridgeshire NHS Peterborough NHS Luton NHS North Essex NHS Suffolk NHS Stoke on Trent and NHS North Staffordshire NHS Devon NHS Torbay NHS Plymouth Central London Healthcare Partnership NHS Oxfordshire NHS Southampton NHS Buckinghamshire NHS Brighton and Hove NHS East Sussex Downs and Weald Medlinc CCG/NHS Surrey KEYSites with live dashboards Sites in implementation phase Further scheduled dashboard deployments

20. Current position: dashboard project • 32 sites now have a live Urgent Care Clinical Dashboard. The dashboard is available to over 1000 GP practices, and covers a patient population of around 6.3 million. This will increase to 2000+ practices and 13.5 million patients when sites currently implementing complete their rollout to GP practices • Early implementers are adding further content to their dashboards, e.g. risk scoring, additional data feeds (e.g. ambulance), a pseudonymised organisation-wide view, yearly activity comparisons • Refined implementation toolkit, templates, tools and guide available to all at our NHS Networks site: www.networks.nhs.uk/nhs-networks/qipp-urgent-care-gp-dashboard • Dashboard User Group established, run by sites for sites

21. Emergent benefits at live dashboard sites

22. Critical success factors

23. Lessons Learned/Key Messages • It’s never too early to engage with clinicians, data providers, or IG leads • Keep focusing on the benefits which the dashboard will deliver • Often, simplest is best • Use the resources and support available; someone has probably solved your problem already! • The dashboard is an enabler; it’s what you do with the information it provides that makes the difference

24. clinical.dashboard@nhs.net www.networks.nhs.uk/nhs-networks/qipp-urgent-care-gp-dashboard QIPP Digital Technology: Working with national and local teams to exploit digital technology in order to accelerate delivery of their QIPP priorities http://www.networks.nhs.uk/nhs-networks/qipp-digital-technology-and-vision qippdt@nhs.net Any questions?