Partnership Meeting – 10th October 2011

The partnership of Thames Valley HIEC met on 10th October at Bucks New University to hear about the outcomes of the Inhaler Technique Improvement Programme; and to meet with one of the local clinical commissioning groups. Partners were welcomed to the University by Ruth Farwell, the Vice Chancellor, who said how pleased she is that the University are to be the new host for Thames Valley HIEC.

There is ample evidence to demonstrate that around 92{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} of patients who regularly use inhalers do not do so correctly.  Perhaps more surprisingly, maybe as many as 94{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} of professionals who work with such patients are not themselves able to assess whether or not the patient’s inhaler technique is correct.  This project set out to address this challenge, using a training inhaler which is an innovation developed locally on the Isle of Wight.  The HIEC worked with all five of our PCTs, to train the professionals who carry out the Medicines Use Reviews for patients who use inhalers.  Richard Freeman, of the HIEC, co-presented the outcomes of this project, together with Nikki Hughes from NHS Milton Keynes, where this project has proved enormously successful.

The presentations can be found here:

Richard Freeman Presentation

Nikki Hughes Presentation

In the following discussion, there was as much interest displayed in the ways this project has been rolled out, as in the improved outcomes for patients.  It seems that factors that contributed to the success of the project included:

  • Local ownership and the commitment of the PCT pharmacy lead
  • The ability to contextualise the work to sit alongside other local initiatives
  • A data system which captures real time data, and therefore allowed the project to be monitored and modified as it was happening
  • A certain amount of peer rivalry as the data on completed MURs was open to all
  • Peer support through the local nature of the networks.

Already, nearly 2000 patients have been reached and this is increasing each month as the MURs continue.  About 75{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} of these patients are in the Thames Valley region, and the rest are across the Wessex area (as this project was a partnership with the Wessex HIEC, funded by the SHA Regional Innovation Fund).  As well as improvements in daily functioning as reported by patients, other positive outcomes include referrals to smoking cessation clinics and closer working between pharmacists and GPs.

In the second half of the meeting, Dr. Amandeep Dosangh presented on the development of the Windsor Ascot and Maidenhead (WAM) clinical commission group (CCG).  The development of CCGs present significant challenges to the NHS, as they are collectives of small businesses which do not function in line with the more traditional organisational models which are familiar to the NHS.  This requires a new way of thinking about both clinical leadership and the nature of multi-disciplinary teams.

In her presentation, Aman took the group though their Board’s thinking in terms of developing their CCG as a learning organisation, and also explored some of the theoretical under-pinnings to the approach they have chosen. In their early days, the Board thought hard about how change has traditionally been managed in the NHS and why maybe these approaches have not worked as well as they could.  The impetus around the current reforms is to improve the model of commissioning, and this therefore requires some analysis and understanding of why what has gone before has not been perceived as successful.  A part of that is that the change processes that are typically implemented by the NHS aim to solve single issues, rather than fundamentally to address wider system problems.

The ambition of WAM is to become a learning organisation, which will be a multi-year project.  Among their quick wins is a reduction in referrals to secondary dermatology services, through systematically addressing the barriers which stopped the majority of cases being dealt with in primary care.  From this early work, they have learnt a lot of lessons about how to implement service redesign, which they will carry forward into the next cycle of learning.

Aman’s presentation is avalible here

In the discussion, members of the audience commented:

  • How interesting it is to hear about the early stages of CCG development
  • That it is important to have robust methods of capturing patient input
  • That there are different kinds of teams – practice based teams and teams that work across the CCG
  • That in long-term change programmes it is helpful to have some visible successes
  • That stakeholder relationships go wider than just into secondary care- for example, they also include the pharmacists we were hearing from in the first session, some of whom work for the private sector.

The meeting concluded with the thanks being offered to Kate Hartley, who has done so much to help establish the Thames Valley HIEC in its first year, and who is now moving on to become a primary school teacher.

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